<?xml version="1.0" encoding="UTF-8"?>
<!DOCTYPE root>
<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="other" dtd-version="1.2" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">Traumatology and Orthopedics of Russia</journal-id><journal-title-group><journal-title xml:lang="en">Traumatology and Orthopedics of Russia</journal-title><trans-title-group xml:lang="ru"><trans-title>Травматология и ортопедия России</trans-title></trans-title-group></journal-title-group><issn publication-format="print">2311-2905</issn><issn publication-format="electronic">2542-0933</issn><publisher><publisher-name xml:lang="en">Vreden National Medical Research Center of Traumatology and Orthopedics</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">136</article-id><article-id pub-id-type="doi">10.21823/2311-2905-2015-0-2-142-150</article-id><article-categories><subj-group subj-group-type="toc-heading" xml:lang="en"><subject>Case Reports</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="ru"><subject>Случаи из практики</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="zh"><subject>Case Reports</subject></subj-group><subj-group subj-group-type="article-type"><subject></subject></subj-group></article-categories><title-group><article-title xml:lang="en">The first case of revealing of Klebsiella pneumoniae ST147, producing NDM-1 carbapenemase, in trauma and orthopedic hospital in Russia</article-title><trans-title-group xml:lang="ru"><trans-title>Первый случай выявления в россии Klebsiella pneumoniae ST147, продуцирующей NDM-1 карбапенемазу, в травматолого-ортопедическом стационаре</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Shabanova</surname><given-names>V. V.</given-names></name><name xml:lang="ru"><surname>Шабанова</surname><given-names>В. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><email>tichvin@yandex.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Krasnova</surname><given-names>M. V.</given-names></name><name xml:lang="ru"><surname>Краснова</surname><given-names>М. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Bozhkova</surname><given-names>S. A.</given-names></name><name xml:lang="ru"><surname>Божкова</surname><given-names>С. А.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Ageevets</surname><given-names>V. A.</given-names></name><name xml:lang="ru"><surname>Агеевец</surname><given-names>В. А.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><xref ref-type="aff" rid="aff2"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Lazareva</surname><given-names>I. V.</given-names></name><name xml:lang="ru"><surname>Лазарева</surname><given-names>И. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><xref ref-type="aff" rid="aff2"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Rukina</surname><given-names>A. N.</given-names></name><name xml:lang="ru"><surname>Рукина</surname><given-names>А. Н.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Sidorenko</surname><given-names>S. V.</given-names></name><name xml:lang="ru"><surname>Сидоренко</surname><given-names>С. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><xref ref-type="aff" rid="aff2"/><xref ref-type="aff" rid="aff3"/></contrib></contrib-group><aff-alternatives id="aff1"><aff><institution xml:lang="en">Vreden Russian Research Institute of Traumatology and Orthopedics</institution></aff><aff><institution xml:lang="ru">ФГБУ «Российский НИИ травматологии и ортопедии им.Р.Р. Вредена» Минздрава России</institution></aff></aff-alternatives><aff-alternatives id="aff2"><aff><institution xml:lang="en">Scientific Research Institute of Children’s Infections</institution></aff><aff><institution xml:lang="ru">ФГБУ «НИИ детских инфекций ФМБА России»</institution></aff></aff-alternatives><aff-alternatives id="aff3"><aff><institution xml:lang="en">Mechnikov North-Western State Medical University</institution></aff><aff><institution xml:lang="ru">ГБОУ ВПО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России</institution></aff></aff-alternatives><pub-date date-type="pub" iso-8601-date="2015-09-12" publication-format="electronic"><day>12</day><month>09</month><year>2015</year></pub-date><volume>21</volume><issue>2</issue><issue-title xml:lang="en"/><issue-title xml:lang="ru"/><fpage>90</fpage><lpage>98</lpage><history><date date-type="received" iso-8601-date="2016-09-12"><day>12</day><month>09</month><year>2016</year></date></history><permissions><copyright-year>2015</copyright-year><ali:free_to_read xmlns:ali="http://www.niso.org/schemas/ali/1.0/"/></permissions><self-uri xlink:href="https://journal.rniito.org/jour/article/view/136">https://journal.rniito.org/jour/article/view/136</self-uri><abstract xml:lang="en"><p>Present report describes the first case of isolation of NDM-1 carbapenemase-producing K. pneumoniae in a patient with wound infection after open tibial fracture. Identical isolates were twice detected in various microbial associations: first time during therapy with ampicillin/sulbactam, second time after the relapse of wound infection during therapy with cephoperazone/sulbactam with vancomycin. The strain of K. pneumoniae was resistant to all beta-lactams, aminoglycosides and fluoroquinolones, but retained susceptibility to tigecycline and polymyxin B. The presence of blaNDM-1 was detected by PCR and Sanger sequencing. On the basis of multilocus sequence typing K. pneumoniae isolate was classified as sequence-type 147 (ST147). Eradication of the pathogen, successful osteosynthesis of tibial bones and skin-muscle flap plasty of the extensive wound were completed together with combined dioxydin and phosphomycin therapy. Due to the danger of the emergence of nosocomial infection sources and of the development of the potentially incurable nosocomial implant-associated infection, detection of NDM-1 carbapenemase-producing K. pneumoniae strain in a trauma and orthopedic in-patient clinic is alarming.</p></abstract><trans-abstract xml:lang="ru"><p>Описан первый случай выделения у пациента травматолого-ортопедического профиля (раневая инфекция после открытого перелома голени) штамма Klebsiella pneumoniae - продуцента карбапенемазы NDM-1. Идентичные изоляты были выделены в составе различных микробных ассоциаций дважды: первый раз на фоне терапии ампициллином/сульбактамом, второй раз - при рецидиве раневой инфекции на фоне терапии цефоперазоном/ сульбактамом и ванкомицином. K. pneumoniae проявляла устойчивость ко всем бета-лактамам, аминогликозидам и фторхинолонам, но сохраняла чувствительность к тигециклину и полимиксину В. Ген bla<sub>NDM</sub><sub>1</sub> был детектирован методом ПЦР и секвенированием по Сэнгеру. На основании мультилокусного сиквенс-типирования изолят K. pneumoniae был отнесен к сиквенс-типу 147 (ST147). Эрадикация возбудителя, успешный остеосинтез костей голени и кожно-мышечная пластика обширной раны были осуществлены при терапии комбинацией диоксидина и фосфомицина. Обнаружение в травматолого-ортопедическом стационаре K. pneumoniae, продуцирующих NDM-1 карбапенемазы, вызывает тревогу ввиду опасности формирования очагов внутрибольничного инфицирования и развития потенциально неизлечимой имплантат-ассоциированной инфекции.</p></trans-abstract><kwd-group xml:lang="ru"><kwd>открытый перелом костей голени</kwd><kwd>раневая инфекция</kwd><kwd>K. pneumoniae</kwd><kwd>карбапенемаза NDM-1</kwd><kwd>open tibial fracture</kwd><kwd>wound infection</kwd><kwd>K. pneumoniae</kwd><kwd>NDM-1 carbapenemase</kwd></kwd-group></article-meta></front><body></body><back><ref-list><ref id="B1"><label>1.</label><mixed-citation>Агеевец В.А., Партина И.В., Лисицына Е.С., Батыршин И.М., Попенко Л.Н., Шляпников С.А., Ильина Е.Н., Сидоренко С.В. Первое обнаружение металло-бета- лактамазы ndm-типа в многопрофильном стационаре в России. Медицинский академический журнал. 2012; (4):43-45.</mixed-citation></ref><ref id="B2"><label>2.</label><mixed-citation>Божкова С.А., Тихилов Р.М., Краснова М.В., Рукина А.Н. Ортопедическая имплантат-ассоциированная инфекция: ведущие возбудители, локальная резистентность и рекомендации по антибактериальной терапии. Травматология и ортопедия России. 2013; 4(70):5-15.</mixed-citation></ref><ref id="B3"><label>3.</label><mixed-citation>Гординская Н.А., Сабирова Е.В., Абрамова Н.В., Дударева Е.В., Митрофанов В.Н. Резистентность основных возбудителей инфекции в отделении гнойной остеологии. Вопросы травматологии и ортопедии. 2012; 1(2):14-17.</mixed-citation></ref><ref id="B4"><label>4.</label><mixed-citation>Егорова С.А., Кафтырева Л.А., Липская Л.В., Коноваленко И.Б., Пясетская М.Ф., Курчикова Т.С., Ведерникова Н.Б., Морозова О.Т., Смирнова М.В., Попенко Л.Н., Любушкина М.И., Савочкина Ю.А., Макарова М.А., Сужаева Л.В., Останкова Ю.В., Иванова М.Н., Павелкович А.М., Наабер П., Сепп Э., Кыльялг С., Мицюлявичене И., Балоде А. Штаммы энтеробактерий, продуцирующие бета-лактамазы расширенного спектра и металло-р-лактамазу ndm-1, выделенные в стационарах в странах балтийского региона. Инфекция и иммунитет. 2013; 1(3):29-36.</mixed-citation></ref><ref id="B5"><label>5.</label><mixed-citation>Розова Л.В., Годовых Н.В. Сравнительная характеристика видового состава микроорганизмов при хроническом посттравматическом и гематогенном остеомиелите. Гений Ортопедии. 2014; (2):56-59.</mixed-citation></ref><ref id="B6"><label>6.</label><mixed-citation>Ageevets V.A., Partina I.V., Lisitsyna E.S., Ilina E.N., Lobzin Y.V., Shlyapnikov S., Sidorenko S.V. Emergence of carbapenemase-producing Gram-negative bacteria in Saint Petersburg, Russia. Int J Antimicrob Agents. 2014; 44(2):152-155.</mixed-citation></ref><ref id="B7"><label>7.</label><mixed-citation>Bessa J.L., Fazii P., Di Giulio M., Cellini L. Bacterial isolates from infected wounds and their antibiotic susceptibility pattern: some remarks about wound infection. Int Wound J. 2015; 12(1): 47-52.</mixed-citation></ref><ref id="B8"><label>8.</label><mixed-citation>Cardoso O., Leitao R., Figueiredo A., Sousa J.C., Duarte A., Peixe L.V. Metallo-beta-lactamase VIM-2 in clinical isolates of Pseudomonas aeruginosa from Portugal. Microbial Drug Resistance. 2002; 8:93-97.</mixed-citation></ref><ref id="B9"><label>9.</label><mixed-citation>De Sanctis J., Teixeira L., van Duin D., Odio C., Hall G., Tomford J.W., Perez F, Rudin S. D., Schmitt S. Complex prosthetic joint infections due to carbapenemase- producing Klebsiella pneumoniae: А unique challenge in the era of untreatable infections. Int J Infect Dise. 2014; 25:73-78.</mixed-citation></ref><ref id="B10"><label>10.</label><mixed-citation>EUCAST Breakpoint tables for interpretation of MICs and zone diameters. Breakpoint tables for interpretation of MICs and zone diameters. Version 2.0. 2012:1-73. Available: http://www.eucast.org/ clinical_breakpoints/</mixed-citation></ref><ref id="B11"><label>11.</label><mixed-citation>EUCAST Breakpoint tables for interpretation of MICs and zone diameters. Breakpoint tables for interpretation of MICs and zone diameters. Version 3.0. 2013:1-76. Available: http://www.eucast.org/clinical_breakpoints/</mixed-citation></ref><ref id="B12"><label>12.</label><mixed-citation>Gupta V., Bansal N., Gupta R., Chander J. Klebsiella pneumoniae carrying bla NDM-1 gene in orthopedic practice. Ind J Orthop. 2014; 48(5): 533-535.</mixed-citation></ref><ref id="B13"><label>13.</label><mixed-citation>Johnson A.P., Woodford N. Global spread of antibiotic resistance: the example of New Delhi metallo-beta- lactamase (NDM)-mediated carbapenem resistance. J Med Microbiol. 2013; 62:499-513.</mixed-citation></ref><ref id="B14"><label>14.</label><mixed-citation>Partina I., Ageevets V., Goncharov A., Zueva L., Sidorenko S. Cross-sectional study of fecal carriage of carbapenem resistant Gram-negative bacteria in Saint Petersburg hospitals. 25th European Congress of Clinical Microbiology and Infectious Diseases, At Copenhagen, Denmark. 2015. Режим доступа: https://www.escmid.org/escmid_ library/online_lecture_library/?search=1¤t_ page=1&amp;search_term=partina</mixed-citation></ref><ref id="B15"><label>15.</label><mixed-citation>Poirel L., Naas T., Nicolas D., Collet L., Bellais S., Cavallo J.D., Nordmann P. Characterization of VIM-2, a carbapenem-hydrolyzing metallo-beta-lactamase and its plasmid- and integron-borne gene from a Pseudomonas aeruginosa clinical isolate in France. Antimicrob Agents Chemother. 2000; 44:891-897.</mixed-citation></ref><ref id="B16"><label>16.</label><mixed-citation>Walsh T.R., Toleman M.A., Poirel L., Nordmann P. Metallo- beta-lactamases: the quiet before the storm? Clin Microbiol Rev. 2005; 18:306-325.</mixed-citation></ref><ref id="B17"><label>17.</label><mixed-citation>Watanabe M., Iyobe S., Inoue M., Mitsuhashi S. Transferable imipenem resistance in Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1991; 35:147-151.</mixed-citation></ref><ref id="B18"><label>18.</label><mixed-citation>Yong D., Toleman M.A., Giske C.G., Cho H.S., Sundman K., Lee K., Walsh T.R. Characterization of a new metallo-beta-lactamase gene, bla (NDM-1), and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrob Agents Chemother. 2009; 53(12): 5046-5054.</mixed-citation></ref></ref-list></back></article>
