Abstract
BackgroundKlebsiella pneumoniae is a frequent nosocomial pathogen causing difficult-to-treat infections worldwide. The prevalence of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-KP) is increasing in China. The aim of this study was to investigate the molecular epidemiology of KPC-KP in a nosocomial outbreak.MethodsFifty-four KPC-KP isolates were consecutively collected between November 2013 and August 2014 during a KPC-KP outbreak in a tertiary care hospital in Beijing, China. Antimicrobial susceptibility was determined by agar dilution. Carbapenemase, extended-spectrum β–lactamase, 16S rRNA methylase, AmpC β-lactamase, and plasmid-mediated quinolone resistance determinants were detected by PCR amplification. The genetic relatedness of isolates was analyzed by pulsed-field gel electrophoresis and multi-locus sequence typing.ResultsAll isolates belonged to ST11 except one isolate which was identified as a new sequence type (ST2040). PFGE profile of genomic DNA revealed seven clusters, of which cluster A and C dominated the KPC-KP outbreak and cluster A was replaced by cluster C during the outbreak. PFGE of genomic DNA, S1-PFGE of plasmids, replicon typing, and drug resistant characteristics showed that clonal spread occurred during the outbreak. When compared with isolates within cluster A, all isolates in cluster C harbored rmtB and showed higher level of resistance to cefepime, amikacin, tobramycin, and tigecycline.ConclusionWe reported a nosocomial outbreak of KPC-KP with clonal replacement and a new sequence type (ST2040) of KP. High degree of awareness and surveillance of KPC-KP should be given to avoid potential outbreaks, especially in ICU wards.
Highlights
Klebsiella pneumoniae is a frequent nosocomial pathogen causing difficult-to-treat infections worldwide
We reported a nosocomial outbreak of Klebsiella pneumoniae carbapenemase (KPC)-Klebsiella pneumoniae (KP) with clonal replacement in our hospital, which involved 54 consecutive patients and mainly occurred in Intensive care unit (ICU) wards
All patients, where the 54 isolates were isolated from, were identified as clinical infections based on the isolation of KPC-producing Klebsiella pneumoniae (KPC-KP) from clinical samples and medical diagnosis established by physicians according to the clinical manifestations and the antibacterial effects
Summary
Klebsiella pneumoniae is a frequent nosocomial pathogen causing difficult-to-treat infections worldwide. The prevalence of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-KP) is increasing in China. The aim of this study was to investigate the molecular epidemiology of KPC-KP in a nosocomial outbreak. Carbapenem-resistant Klebsiella pneumoniae (KP) has spread worldwide and become a major public health threat in health care facilities [1], and the mortality could reach up to 40–50% [2]. According to an antimicrobial resistance surveillance networks in China (CHINET), the rate of carbapenem-resistant KP escalated from 0.7% in 2006 to 10% in 2013 [3], which is mainly due to the rapid dissemination of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella. We reported a nosocomial outbreak of KPC-KP with clonal replacement in our hospital, which involved 54 consecutive patients and mainly occurred in ICU wards. The drug resistance and epidemiologic features of KPC-KP were described.
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