{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,1]],"date-time":"2026-11-01T03:08:55Z","timestamp":1793502535910,"version":"4.5.0"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T00:00:00Z","timestamp":1675209600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:p>\n                    Infections caused by multi-drug resistant\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    are a leading cause of mortality and morbidity among hospitalized patients. In neonatal intensive care units (NICU), blood stream infections by\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    are one of the most common nosocomial infections leading to poor clinical outcomes and prolonged hospital stays. Here, we describe an outbreak of multi-drug resistant\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    among neonates admitted at the NICU of a large tertiary care hospital in India. The outbreak involved 5 out of 7 neonates admitted in the NICU. The antibiotic sensitivity profiles revealed that all\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    isolates were multi-drug resistant including carbapenems and colistin. The isolates belonged to three different sequence types namely, ST-11, ST-16 and ST-101. The isolates harboured carbapenemase genes, mainly\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM-1<\/jats:sub>\n                    ,\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM-5<\/jats:sub>\n                    and\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-232<\/jats:sub>\n                    besides extended-spectrum \u03b2-lactamases however the colistin resistance gene\n                    <jats:italic>mcr-1<\/jats:italic>\n                    ,\n                    <jats:italic>mcr-2 and mcr-3<\/jats:italic>\n                    could not be detected. Extensive environmental screening of the ward and healthcare personnel led to the isolation of\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    ST101 from filtered incubator water, harboring\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>NDM-5<\/jats:sub>\n                    ,\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>OXA-232<\/jats:sub>\n                    and ESBL genes (\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CTX-M<\/jats:sub>\n                    ) but was negative for the\n                    <jats:italic>mcr<\/jats:italic>\n                    genes. Strict infection control measures were applied and the outbreak was contained. This study emphasizes that early detection of such high-risk clones of multi-drug resistant isolates, surveillance and proper infection control practices are crucial to prevent outbreaks and further spread into the community.\n                  <\/jats:p>","DOI":"10.3389\/fcimb.2023.1051020","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T02:58:00Z","timestamp":1675220280000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":35,"title":["Outbreak of colistin resistant, carbapenemase (blaNDM, blaOXA-232) producing Klebsiella pneumoniae causing blood stream infection among neonates at a tertiary care hospital in India"],"prefix":"10.3389","volume":"13","author":[{"given":"Ashutosh","family":"Pathak","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nidhi","family":"Tejan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akanksha","family":"Dubey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Radha","family":"Chauhan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nida","family":"Fatima","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"family":"Jyoti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sushma","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahil","family":"Bhayana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinmoy","family":"Sahu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,2,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1186\/s13756-017-0208-x","article-title":"The threat of antimicrobial resistance in developing countries: causes and control strategies","volume":"6","author":"Ayukekbong","year":"2017","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B2","doi-asserted-by":"publisher","first-page":"41","DOI":"10.4103\/0974-777X.176149","article-title":"Laboratory detection and clinical implication of oxacillinase-48 like carbapenemase: The hidden threat","volume":"8","author":"Bakthavatchalam","year":"2016","journal-title":"J. Glob Infect. Dis."},{"key":"B3","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1186\/s12887-019-1709-y","article-title":"A review of -multidrug-resistant enterobacteriaceae in a neonatal unit in Johannesburg, south Africa","volume":"19","author":"Ballot","year":"2019","journal-title":"BMC Pediatr."},{"key":"B4","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1016\/j.jgar.2021.03.024","article-title":"Carbapenemase-producing gram-negative bacteria in aquatic environments: a review","volume":"25","author":"Cherak","year":"2021","journal-title":"J. Glob Antimicrob. Resist."},{"key":"B5","volume-title":"Performance standards for antimicrobial susceptibility testing","year":"2021"},{"key":"B6","doi-asserted-by":"publisher","first-page":"183","DOI":"10.1016\/j.ajic.2006.06.013","article-title":"A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units","volume":"35","author":"Couto","year":"2007","journal-title":"Am. J. Infect. Control"},{"key":"B7","doi-asserted-by":"publisher","first-page":"4178","DOI":"10.1128\/JCM.43.8.4178-4182.2005","article-title":"Multilocus sequence typing of Klebsiella pneumoniae nosocomial isolates","volume":"43","author":"Diancourt","year":"2005","journal-title":"J. Clin. Microbiol."},{"key":"B8","doi-asserted-by":"publisher","first-page":"385.e1","DOI":"10.1016\/j.cmi.2018.11.004","article-title":"Genomics of Klebsiella pneumoniae ST16 producing NDM-1, CTX-M-15, and OXA-232","volume":"25","author":"Espinal","year":"2019","journal-title":"Clin. Microbiol. Infect."},{"key":"B9","doi-asserted-by":"publisher","first-page":"208","DOI":"10.1093\/cid\/cix270","article-title":"Gastrointestinal carriage is a major reservoir of Klebsiella pneumoniae infection in intensive care patients","volume":"65","author":"Gorrie","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.01375","article-title":"Extensively-drug resistant Klebsiella pneumoniae recovered from neonatal sepsis cases from a major NICU in Egypt","volume":"11","author":"Hassuna","year":"2020","journal-title":"Front. Microbiol."},{"key":"B11","doi-asserted-by":"publisher","first-page":"24","DOI":"10.1186\/s12941-020-00366-y","article-title":"Emerging high-risk ST101 and ST307 carbapenem-resistant Klebsiella pneumoniae clones from bloodstream infections in southern Italy","volume":"19","author":"Loconsole","year":"2020","journal-title":"Ann. Clin. Microbiol. Antimicrob."},{"key":"B12","doi-asserted-by":"publisher","first-page":"S300","DOI":"10.1093\/cid\/ciab767","article-title":"High-resolution genomic profiling of carbapenem-resistant Klebsiella pneumoniae isolates: A multicentric retrospective Indian study","volume":"73","author":"Nagaraj","year":"2021","journal-title":"Clin. Infect. Dis."},{"key":"B13","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1093\/femsre\/fux013","article-title":"Klebsiella pneumoniae: a major worldwide source and shuttle for antibiotic resistance","volume":"41","author":"Navon-Venezia","year":"2017","journal-title":"FEMS Microbiol. Rev."},{"key":"B14","doi-asserted-by":"publisher","first-page":"4275","DOI":"10.1128\/AAC.02813-13","article-title":"High incidence and endemic spread of NDM-1-positive enterobacteriaceae in henan province, China","volume":"58","author":"Qin","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"B15","doi-asserted-by":"publisher","first-page":"59","DOI":"10.4103\/0300-1652.103543","article-title":"Healthcare - associated infections: A public health problem","volume":"53","author":"Revelas","year":"2012","journal-title":"Niger Med. J."},{"key":"B16","doi-asserted-by":"publisher","first-page":"675","DOI":"10.1055\/s-0034-1393936","article-title":"Canadian Neonatal network. risk factors and outcomes of late-onset bacterial sepsis in preterm neonates born at\u2009<\u200932 weeks' gestation","volume":"32","author":"Shah","year":"2015","journal-title":"Am. J. Perinatol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"927","DOI":"10.1099\/jmm.0.000767","article-title":"KPC-2 producing ST101 Klebsiella pneumoniae from bloodstream infection in India","volume":"67","author":"Shankar","year":"2018","journal-title":"J. Med. Microbiol."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-021-01048-w","article-title":"Extensive outbreak of colistin resistant, carbapenemase (blaOXA-48, blaNDM) producing Klebsiella pneumoniae in a large tertiary care hospital, India","volume":"11","author":"Sharma","year":"2022","journal-title":"Antimicrob. Resist. Infect. Control"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e01885","DOI":"10.1128\/AAC.01885-17","article-title":"Emergence of chromosome-borne colistin resistance gene mcr-1 in clinical isolates of Klebsiella pneumoniae from India","volume":"62","author":"Singh","year":"2018","journal-title":"Antimicrob. Agents Chemother."},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.666030","article-title":"Genetic characterisation of colistin resistant Klebsiella pneumoniae clinical isolates from north India","volume":"11","author":"Singh","year":"2021","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B21","doi-asserted-by":"publisher","first-page":"1363","DOI":"10.1007\/s10096-016-2673-1","article-title":"Etiology and antibiotic susceptibility of bacterial pathogens responsible for community-acquired urinary tract infections in Poland","volume":"35","author":"Stefaniuk","year":"2016","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"B22","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1016\/j.ijid.2014.05.011","article-title":"Hospital-acquired infection rate in a tertiary care teaching hospital in China: a cross-sectional survey involving 2434 inpatients","volume":"27","author":"Tao","year":"2014","journal-title":"Int. J. Infect. Dis."},{"key":"B23","doi-asserted-by":"publisher","first-page":"2233","DOI":"10.1128\/jcm.33.9.2233-2239.1995","article-title":"Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing","volume":"33","author":"Tenover","year":"1995","journal-title":"J. Clin. Microbiol."},{"key":"B24","unstructured":"Breakpoint tables for interpretation of MICs and zone diameters. version 11.02021"},{"key":"B25","doi-asserted-by":"publisher","first-page":"944","DOI":"10.1016\/j.tim.2016.09.007","article-title":"Klebsiella pneumoniae population genomics and antimicrobial-resistant clones","volume":"24","author":"Wyres","year":"2016","journal-title":"Trends Microbiol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1038\/s41579-019-0315-1","article-title":"Population genomics of klebsiella pneumoniae","volume":"18","author":"Wyres","year":"2020","journal-title":"Nat. Rev. Microbiol."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2023.1051020\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T02:58:05Z","timestamp":1675220285000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2023.1051020\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,1]]},"references-count":26,"alternative-id":["10.3389\/fcimb.2023.1051020"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2023.1051020","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,1]]},"article-number":"1051020"}}