Rapid communication Open Access
Like 0


New Delhi metallo-beta-lactamase (NDM)-producing () ST147 caused a large multi-hospital outbreak in Italy from 2018 to 2021. We describe a new ST6668 NDM-producing clone, belonging to CC147, which rapidly spread across hospitals in the Pavia province (Northern Italy) from February to August 2023. Genomic analyses revealed that ST6668 is different from ST147 and fast evolving. As shown here, genomic surveillance programmes are useful for tracking the spread of new clones with reduced susceptibility to most antibiotics.


Article metrics loading...

Loading full text...

Full text loading...



  1. Tamma PD, Aitken SL, Bonomo RA, Mathers AJ, van Duin D, Clancy CJ. Infectious Diseases Society of America 2023 guidance on the treatment of antimicrobial resistant Gram-negative infections. Clin Infect Dis. 2023;ciad428.  https://doi.org/10.1093/cid/ciad428  PMID: 37463564 
  2. Peirano G, Chen L, Kreiswirth BN, Pitout JDD. Emerging antimicrobial-resistant high-risk Klebsiella pneumoniae clones ST307 and ST147. Antimicrob Agents Chemother. 2020;64(10):e01148-20.  https://doi.org/10.1128/AAC.01148-20  PMID: 32747358 
  3. Di Pilato V, Henrici De Angelis L, Aiezza N, Baccani I, Niccolai C, Parisio EM, et al. Resistome and virulome accretion in an NDM-1-producing ST147 sublineage of Klebsiella pneumoniae associated with an outbreak in Tuscany, Italy: a genotypic and phenotypic characterisation. Lancet Microbe. 2022;3(3):e224-34.  https://doi.org/10.1016/S2666-5247(21)00268-8  PMID: 35544076 
  4. Martin MJ, Corey BW, Sannio F, Hall LR, MacDonald U, Jones BT, et al. Anatomy of an extensively drug-resistant Klebsiella pneumoniae outbreak in Tuscany, Italy. Proc Natl Acad Sci USA. 2021;118(48):e2110227118.  https://doi.org/10.1073/pnas.2110227118  PMID: 34819373 
  5. Merla C, Kuka A, Petazzoni G, Postiglione U, Zatelli M, Gaiarsa S, et al. Livestock-associated methicillin-resistant Staphylococcus aureus in inpatients: a snapshot from an Italian hospital. J Glob Antimicrob Resist. 2022;30:10-5.  https://doi.org/10.1016/j.jgar.2022.05.013  PMID: 35644436 
  6. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. Version 13.0. Växjö: EUCAST; 2023. Available from: https://www.eucast.org
  7. Wenzler E, Deraedt MF, Harrington AT, Danizger LH. Synergistic activity of ceftazidime-avibactam and aztreonam against serine and metallo-β-lactamase-producing gram-negative pathogens. Diagn Microbiol Infect Dis. 2017;88(4):352-4.  https://doi.org/10.1016/j.diagmicrobio.2017.05.009  PMID: 28602518 
  8. Batisti Biffignandi G, Bellinzona G, Petazzoni G, Sassera D, Zuccotti GV, Bandi C, et al. P-DOR, an easy-to-use pipeline to reconstruct bacterial outbreaks using genomics. Bioinformatics. 2023;39(9):btad571.  https://doi.org/10.1093/bioinformatics/btad571  PMID: 37701995 
  9. Lam MMC, Wick RR, Watts SC, Cerdeira LT, Wyres KL, Holt KE. A genomic surveillance framework and genotyping tool for Klebsiella pneumoniae and its related species complex. Nat Commun. 2021;12(1):4188.  https://doi.org/10.1038/s41467-021-24448-3  PMID: 34234121 
  10. Carattoli A, Zankari E, García-Fernández A, Voldby Larsen M, Lund O, Villa L, et al. In silico detection and typing of plasmids using PlasmidFinder and plasmid multilocus sequence typing. Antimicrob Agents Chemother. 2014;58(7):3895-903.  https://doi.org/10.1128/AAC.02412-14  PMID: 24777092 
  11. Gullberg E, Albrecht LM, Karlsson C, Sandegren L, Andersson DI. Selection of a multidrug resistance plasmid by sublethal levels of antibiotics and heavy metals. MBio. 2014;5(5):e01918-14.  https://doi.org/10.1128/mBio.01918-14  PMID: 25293762 
  12. Ciccolini M, Donker T, Köck R, Mielke M, Hendrix R, Jurke A, et al. Infection prevention in a connected world: the case for a regional approach. Int J Med Microbiol. 2013;303(6-7):380-7.  https://doi.org/10.1016/j.ijmm.2013.02.003  PMID: 23499307 
  13. Forde BM, Bergh H, Cuddihy T, Hajkowicz K, Hurst T, Playford EG, et al. Clinical implementation of routine whole-genome sequencing for hospital infection control of multi-drug resistant pathogens. Clin Infect Dis. 2023;76(3):e1277-84.  https://doi.org/10.1093/cid/ciac726  PMID: 36056896 
  14. Kwong JC, Lane CR, Romanes F, Gonçalves da Silva A, Easton M, Cronin K, et al. Translating genomics into practice for real-time surveillance and response to carbapenemase-producing Enterobacteriaceae: evidence from a complex multi-institutional KPC outbreak. PeerJ. 2018;6:e4210.  https://doi.org/10.7717/peerj.4210  PMID: 29312831 
  15. Vink JP, Otter JA, Edgeworth JD. Carbapenemase-producing Enterobacteriaceae - once positive always positive? Curr Opin Gastroenterol. 2020;36(1):9-16.  https://doi.org/10.1097/MOG.0000000000000596  PMID: 31633563 

Data & Media loading...

Supplementary data

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error