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Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae at a single institution : insights into endemicity from whole-genome sequencing
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Mathers, Amy J., Stoesser, Nicole, Sheppard, Anna E., Pankhurst, Louise, Giess, Adam, Yeh, Anthony J., Didelot, Xavier, Turner, Stephen D., Sebra, Robert, Kasarskis, Andrew, Peto, Tim, Crook, Derrick and Sifri, Costi D. (2015) Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae at a single institution : insights into endemicity from whole-genome sequencing. Antimicrobial Agents and Chemotherapy, 59 (3). pp. 1656-1663. doi:10.1128/AAC.04292-14 ISSN 0066-4804.
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Official URL: http://dx.doi.org/10.1128/AAC.04292-14
Abstract
The global emergence of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) multilocus sequence type ST258 is widely recognized. Less is known about the molecular and epidemiological details of non-ST258 K. pneumoniae in the setting of an outbreak mediated by an endemic plasmid. We describe the interplay of blaKPC plasmids and K. pneumoniae strains and their relationship to the location of acquisition in a U.S. health care institution. Whole-genome sequencing (WGS) analysis was applied to KPC-Kp clinical isolates collected from a single institution over 5 years following the introduction of blaKPC in August 2007, as well as two plasmid transformants. KPC-Kp from 37 patients yielded 16 distinct sequence types (STs). Two novel conjugative blaKPC plasmids (pKPC_UVA01 and pKPC_UVA02), carried by the hospital index case, accounted for the presence of blaKPC in 21/37 (57%) subsequent cases. Thirteen (35%) isolates represented an emergent lineage, ST941, which contained pKPC_UVA01 in 5/13 (38%) and pKPC_UVA02 in 6/13 (46%) cases. Seven (19%) isolates were the epidemic KPC-Kp strain, ST258, mostly imported from elsewhere and not carrying pKPC_UVA01 or pKPC_UVA02. Using WGS-based analysis of clinical isolates and plasmid transformants, we demonstrate the unexpected dispersal of blaKPC to many non-ST258 lineages in a hospital through spread of at least two novel blaKPC plasmids. In contrast, ST258 KPC-Kp was imported into the institution on numerous occasions, with other blaKPC plasmid vectors and without sustained transmission. Instead, a newly recognized KPC-Kp strain, ST941, became associated with both novel blaKPC plasmids and spread locally, making it a future candidate for clinical persistence and dissemination.
Item Type: | Journal Article | ||||||
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Divisions: | Faculty of Science, Engineering and Medicine > Science > Life Sciences (2010- ) | ||||||
Journal or Publication Title: | Antimicrobial Agents and Chemotherapy | ||||||
Publisher: | American Society for Microbiology | ||||||
ISSN: | 0066-4804 | ||||||
Official Date: | 11 February 2015 | ||||||
Dates: |
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Volume: | 59 | ||||||
Number: | 3 | ||||||
Page Range: | pp. 1656-1663 | ||||||
DOI: | 10.1128/AAC.04292-14 | ||||||
Status: | Peer Reviewed | ||||||
Publication Status: | Published | ||||||
Access rights to Published version: | Open Access (Creative Commons) |
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