{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T20:57:11Z","timestamp":1790456231784,"version":"4.1.0"},"reference-count":45,"publisher":"SAGE Publications","issue":"8","license":[{"start":{"date-parts":[[2018,10,1]],"date-time":"2018-10-01T00:00:00Z","timestamp":1538352000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2018,10]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>\n                      To describe clinical and molecular characteristics of an outbreak due to metallo-\u03b2-lactamases (MBLs) producing\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      collected at Charles Nicolle Hospital of Tunis and to analyze the impact of outer membrane porin (OMP) loss on carbapenem resistance levels.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Between 2010 and 2015, 178 carbapenem-resistant\n                      <jats:italic toggle=\"yes\">Enterobacteriaceae<\/jats:italic>\n                      were isolated. Screening for MBL production was performed using combined disk diffusion method, with imipenem and ethylene diamine tetraacetic acid (EDTA) as inhibitors. Resistance genes and virulence factors were identified by polymerase chain reaction (PCR) and sequencing. Genotyping was performed by pulsed-field gel electrophoresis and multilocus sequence typing. Genetic environment of carbapenemase genes was determined by PCR mapping. Conjugation assays were performed, and plasmids were assigned to incompatibility groups by PCR-based replicon typing. OMPs were profiled by sodium dodecyl sulfate-polyacrilamide gel electrophoresis, and porin genes were sequenced.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Nineteen\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      (10.6%) showing MBL activity were isolated from patients hospitalized on four different wards. NDM-1 was the only MBL identified, in association with\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>OXA-48<\/jats:sub>\n                      . All strains lacked at least one OMP, and carbapenem resistance levels were remarkably elevated in strains lacking OmpK35 and OmpK36.\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>NDM-1<\/jats:sub>\n                      was located in IncFIA-type conjugative plasmid, with the same genetic context in all strains. The epidemiological diffusion of\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>NDM-1<\/jats:sub>\n                      was due to two clones, one major clone belonging to sequence type (ST) 147 (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200916) and the other clone belonging to ST307 (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u20093).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>\n                      This study describes an outbreak of NDM-1-producing\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      strains, isolated from a Tunisian hospital, caused by two clones belonging to ST147 and ST307; and highlights the role of OMPs loss, in combination with \u03b2-lactamase expression, in conferring high carbapenem resistance.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/mdr.2017.0165","type":"journal-article","created":{"date-parts":[[2018,1,26]],"date-time":"2018-01-26T15:20:38Z","timestamp":1516980038000},"page":"1137-1147","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":47,"title":["An Outbreak of NDM-1-Producing\n                    <i>Klebsiella pneumoniae<\/i>\n                    , Associated with OmpK35 and OmpK36 Porin Loss in Tunisia"],"prefix":"10.1177","volume":"24","author":[{"given":"Zaineb","family":"Hamzaoui","sequence":"first","affiliation":[{"name":"University of Tunis El Manar","place":["Tunisia"]},{"name":"University of 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Carthage","place":["Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samia","family":"Hammami","sequence":"additional","affiliation":[{"name":"University of Tunis El Manar","place":["Tunisia"]},{"name":"University of Carthage","place":["Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarra","family":"Harbaoui","sequence":"additional","affiliation":[{"name":"University of Tunis El Manar","place":["Tunisia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalie","family":"Genel","sequence":"additional","affiliation":[{"name":"University Pierre et Marie Curie","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guillaume","family":"Arlet","sequence":"additional","affiliation":[{"name":"University Pierre et Marie Curie","place":["France"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mabrouka","family":"Saidani","sequence":"additional","affiliation":[{"name":"University of 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