The First Klebsiella pneumoniae Isolate Co-Producing OXA-48 and NDM-1 in Turkey

the test results were interpreted by using the CLSI criteria. The Modified Hodge test (MHT) was used to screen for the production of carbapenemase, and carbapenem-resistant isolates were examined by using real-time polymerase chain reaction for the expression of blaKPC, blaNDM-1, and blaOXA-48 [5, 6]. The nucleotide sequences were then analyzed by using an Applied Biosystems sequencer (ABI Prism 310 genetic analyzer; PE Applied Biosystems, Foster City, CA, USA). Multiple alignments were performed by using DNAMAN 4.1 software (Lynnon BioSoft, Quebec, Canada) for isolates producing NDM-1. Forty-nine of the 887 Enterobacteriaceae isolates (5.52%) were resistant to ≥1 of the three carbapenems (imipenem, meropenem, and ertapenem), and MHT revealed that all 49isolates were strong carbapenemase producers. No isolates harbored blaKPC, although 48 harbored blaOXA-48, and 1 K. pneumoniae isolate that was recovered from a patient’s urine sample was positive for both blaOXA-48 and blaNDM-1. This patient was a 75-yr-old woman who was living in Sanliurfa (on the southeastern border of Turkey) and was diagnosed as having chronic obstructive pulmonary disease, pneumonia, and hypotension. In 2013, she was transferred to the Pulmonary Diseases Department of a hospital in the central region of Turkey with severe shortness of breath, sluggishness, reduced consciousness, and weakness in her legs and arms. On the day after her admission, she developed severe respiratory fail