Swedish patient of Indian origin with a history of medical treatment in a New Delhi hospital for a urinary tract infection (12). Since then, more such cases in different parts of the world have been reported (6). The majority of these patients were found to have traveled to or been admitted to hospitals in the Indian subcontinent. A few patients had a travel history in the Balkan area (11). Here we describe a Dutch patient proven to be carrying an NDM-1-producing K. pneumoniae strain that was imported from the Balkan area. Furthermore, a second patient apparently acquired this strain during her stay in the same hospital as the index case.

Patient A, a 66-year-old female with a cerebrovascular accident, was transferred from a hospital in Belgrade, Serbia, to the neurology department of a hospital in the east of the Netherlands on 27 August 2008. Since the patient was known to carry methicillin-resistant Staphylococcus aureus (MRSA), she was directly placed in a separate room in isolation. During admission, extended-spectrum ß-lactamase (ESBL)-producing K. pneumoniae, as determined according to the 2008 CLSI guidelines (2), was isolated from different sites, including throat, rectum, and urinary tract. The patient was treated for the urinary tract infection with nitrofurantoin, to which the isolate was susceptible, and with removal of the urinary catheter. She was discharged from the hospital on 15 October to a nursing home, where contact isolation measures were maintained. Follow-up screening cultures remained positive for ESBL-producing K. pneumoniae up to March 2009, but subsequent cultures obtained on several occasions between April and September 2009 were negative.