Go to the wording of the novel metal-No-lactamase named New Delhi metallo-No-lactamase (NDM-1) was determined with Klebsiella pneumonia and Escherichia coli strains in Sweden in a patient previously hospitalized in India (1). NDM-1 spreading rapidly around the world nonclonally related strains, many of which directly or indirectly comments on the Indian subcontinent (
2). Karbapenem resistant K. pneumonia
voltage, KLZA, was isolated in May 2009 with the culture of blood from 40-year-old man the day after his arrival in the surgical intensive resuscitation in the hospital center in Zagreb, Croatia. The patient was transferred after 5 days in hospital in Bosnia and Herzegovina after the car accident. Clinical history is mentioned antibiotic therapy drug that does not include karbapenemy (gentamicin, metronidazole and ceftriaxone) and no reference to the Indian subcontinent. Sensitivity to antimicrobial drugs was performed Vitek2 (bioMts © rieux, Marcy-lBЂ ™ Etoile, France) and broth mikrorozveden and interpreted according to recent documents of the European Committee for susceptibility to strattera dosing antimicrobial drugs (version 1. 1). Strain was resistant to imipenem and meropenem, all broad spectrum cephalosporins and aminoglycosides and ciprofloxacin and sensitive to Tigecycline (
). We tested for
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,
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bla gene resistance by PCR. PCR product was obtained only with primers NDM, after being purified (QIAquick PCR Purification Kit, QIAGEN, Hilden, Germany), the sequence showed 100% identity with
blah. Strain genotyping was performed multilokusnyh sequence set to determine the sequence type (ST) in isolation and a comparison with previously reported NDM-1BЂ "production isolates. Allelic numbers were derived based on sequences of gene 7 economy. Multilokusnye input sequence set
K
KLZA pneumonia as the ST25 strain that differs from ST14-type found in the index NDM-1BЂ "produces strain and other strains originating from India (
1), and in other countries. ST25
K. pneumonia was also found in K. pneumonia
isolates in Geneva (3). Other
K. pneumonia SC concealment NDM-1 were ST15, ST16 and ST147 (
4 BЂ "7). Resistance was transferred to E. coli combination
J53, with a choice based on growth on agar in the presence of ceftazidime (10 mg / l) and azide (100 mg / l). Conjugant T1 showed no resistance to-lactams, including all karbapenemy and reduced susceptibility to ciprofloxacin. KLZA strain and transconjugant cherished another determinant of resistance, namely,, and
qnrA6. Plasmids of incompatibility group, based on PCR input replikon belonged to the Inca / C replikon type. This report NDM-1BЂ "producing K. pneumonia
in Croatia adds other cases in patients, hospitalized in the region of the Balkans. The patient in this report was not apparent reference to the Indian subcontinent. The poll, conducted by the European Centre for Disease Control and Prevention to collect information on the distribution of NDM-1BЂ "producing Enterobacteriaceae in Europe and the cases of 13 countries during 2008BЂ" in 2010, five of 55 individuals with a known history of trips traveled in Balkan region during the month before the diagnosis of infection: 2 in Kosovo and 1 in Serbia, Montenegro and Bosnia and Herzegovina. All of them received hospital treatment in the Balkan countries through illness or accident, which occurred during the trip (
7). The last two cases (
4
8), and the case of Germany (9) were subsequently published. No patient had an obvious reference to the Indian subcontinent. While on the way NDM-1 isolates may have been imported into Western Europe not only from India but also from Balkan countries (10) was isolated, knowledge about Western Europe as one of the possible areas of endemic remains limited. The above report from Germany, although recognizing that the patient was repatriated after hospitalization in Serbia, said BЂњno data about contacts with people from regions where the NDM-enterobacteria are endemicBЂ "(
9). This limited understanding of the threat shows disrespect to screen patients who are transferred from a country not considered at risk for NDM-1. In addition, it means that the sample is sent to local reference laboratories and is recognized as a positive for NDM-1, allowing widespread NDM-1BЂ "producing Enterobacteriaceae in the community (
4). Accumulated evidence NDM-1 from the Balkan region could offer possible multifocal distribution of this enzyme in the Balkans as a possible second endemic area, in addition to India, and offers a wide surveillance. ,,,,,,
Description of new metallo--lactamase gene None
blah, and new gene erythromycin esterase produced by a unique genetic structure in Klebsiella pneumonia
sequence type 14 from India ... ,,. New Delhi metallo-beta-lactamase (NDM-1): Towards a new pandemic .. ,,,,,. Molecular analysis of the NDM-1BЂ "producing Enterobacteriaceae isolates from Geneva, Switzerland ... , Bouchahrouf W, de Castro RR, Deplano, Berhin C, Pits © Gerard D, et al. The emergence of NDM-1BЂ "producing Enterobacteriaceae in Belgium ... ,,,,. New Delhi metallo-No-lactamases in Klebsiella pneumonia and Escherichia coli, Canada ... ,,,,,. Karbapenemov resistance in Klebsiella pneumonia due to New Delhi metallo-lactamase-No ... ,,,,. European NDM-one participants in the survey. New Delhi metallo-beta-lactamase 1BЂ "production
Enterobacteriaceae: occurrence and responses in Europe .. : PII: 19716. ,,,,,,
Global distribution New Delhi metallo--lactamase No. 1 ... ,,,,,,
Global distribution New Delhi metallo--lactamase No. 1 ... ,,,. Balkan NDM-1: diversion or transfer .. Klebsiella pneumonia and transconjugant and recipient DOI: 10. 3201/eid1803. 110389
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