{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:08:57Z","timestamp":1793502537805,"version":"4.5.0"},"reference-count":34,"publisher":"Microbiology Society","issue":"4","license":[{"start":{"date-parts":[[2016,7,11]],"date-time":"2016-07-11T00:00:00Z","timestamp":1468195200000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,7,11]]},"abstract":"<jats:sec sec-type=\"intro\">\n                  <jats:title>Introduction:<\/jats:title>\n                  <jats:p>Extended-spectrum \u03b2-lactamase (ESBL)-producing Enterobacteriaceae, multidrug-resistant (MDR) pathogens, are increasingly implicated in nosocomial outbreaksworldwide, particularly in neonatal intensive care units (NICUs). <jats:italic>Proteus mirabilis<\/jats:italic> is an uncommon nosocomial pathogen causing sepsis in neonates.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case Presentation:<\/jats:title>\n                  <jats:p>We report an outbreak of ESBL-positive MDR <jats:italic>P. mirabilis<\/jats:italic> sepsis involving five babies within 10 days in a NICU, which was promptly detected and managed. The aim of this study was to characterize the molecular mechanism of resistance to third-generation cephalosporins (3GCs) in the bacteria. Surveillance cultures were collected from health-care personnel (hand swabs, urine) and the surrounding patient-care environment. Ribotyping was performed to determine the clonality of the strain. Thirteen <jats:italic>P. mirabilis<\/jats:italic> were recovered from the blood cultures of the five babies and surveillance cultures. Twelve isolates were positive for the VEB-1 ESBL type, and were susceptible only to ciprofloxacin and carbapenems. There was an unusual phenotypic synergy observed between the 3GCs and imipenem\/cefoxitin. The source of infection was traced to a contaminated multidose vial. The outbreak was associated with a high mortality (80\u2009%). A change of empirical antibiotic policy to ciprofloxacin, with strict infection control measures, brought the outbreak to an abrupt end.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec sec-type=\"conclusions\">\n                  <jats:title>Conclusion:<\/jats:title>\n                  <jats:p> This is believed to be the first report of a nosocomial outbreak of VEB-1 ESBL-producing <jats:italic>P. mirabilis<\/jats:italic> sepsis in neonates from India. The present report of infection due to VEB-1-producing <jats:italic>P. mirabilis<\/jats:italic>, an uncommon pathogen for an epidemic in a neonatal unit, highlights the growing significance of such Gram-negative bacteria as a cause of infections in newborns. Epidemic spread in a neonatal unit of an ESBL-producing <jats:italic>Proteus<\/jats:italic> species, which also had an intrinsically reduced susceptibility to imipenem, and resistance to colistin and tigecycline, can be a threatening situation and can result in high neonatal mortality unless recognized and controlled in a timely manner.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1099\/jmmcr.0.005056","type":"journal-article","created":{"date-parts":[[2016,6,29]],"date-time":"2016-06-29T11:09:37Z","timestamp":1467198577000},"source":"Crossref","is-referenced-by-count":22,"title":["VEB-1 extended-spectrum \u03b2-lactamase-producing multidrug-resistant Proteus mirabilis sepsis outbreak in a neonatal intensive care unit in India: clinical and diagnostic implications"],"prefix":"10.1099","volume":"3","author":[{"given":"Sarika","family":"Jain","sequence":"first","affiliation":[{"name":"Department of Microbiology, VMMC and Safdarjang Hospital, New Delhi 110029, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajni","family":"Gaind","sequence":"additional","affiliation":[{"name":"Department of Microbiology, VMMC and Safdarjang Hospital, New Delhi 110029, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charu","family":"Kothari","sequence":"additional","affiliation":[{"name":"Department of Microbiology, VMMC and Safdarjang Hospital, New Delhi 110029, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachna","family":"Sehgal","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, VMMC and Safdarjang Hospital, New Delhi 110029, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Shamweel","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Vallabhbhai Patel Chest Institute, New Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. 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