Genomic surveillance detects interregional spread of New Delhi metallo-beta-lactamase-1-producing in hospitals, Romania, December 2021 to September 2023.

BackgroundNew Delhi metallo-beta-lactamase (NDM)-producing has been reported from European Union/European Economic Area (EU/EEA) countries with increasing frequency. During 2018 to 2022, 355 cases of NDM-producing were detected in seven hospitals reporting on NDM-production in Enterobacterales in Romania.AimOur aim was to determine the extent of spread of NDM-producing in hospitals in Romania.MethodsWe analysed whole genome sequences and epidemiological data of 74 isolates collected in six hospitals from December 2021 to September 2023.ResultsWe identified four multi-hospital clusters including isolates detected over more than a year, indicating sustained spread of -carrying within the healthcare system. These clusters consisted of isolates from up to four hospitals and three regions. Three multi-hospital clusters were caused by a specific multidrug-resistant sequence type 46 lineage carrying and a large set of additional resistance markers. Investigation in an international context showed that this lineage had already been detected in nine countries (Bulgaria, France, Germany, Ireland, the Netherlands, Romania, Switzerland, United Kingdom, United States) since 2015.ConclusionOur results alert about the risk of carbapenem-resistant transmission in healthcare settings. Enhanced infection prevention and control measures should be instituted as soon as cases are detected in healthcare facilities. National surveillance systems in EU/EEA countries should, in addition to carbapenem-resistant and/or carbapenemase-producing and , consider reporting carbapenem-resistant and/or carbapenemase-producing and other Enterobacterales where relevant.