Abstract
The presence of carbapenem-producing Klebsiella pneumoniae (CP-Kp) is a serious threat to the control of nosocomial infections. Plasmid-mediated horizontal transfer of the resistance gene makes it difficult to control hospital-acquired CP- Kp infections. Nine CP- Kp strains were isolated during an outbreak in the intensive care unit of Shanghai Huashan hospital in east China. We conducted a retrospective study to identify the origin and route of transmission of this CP-Kp outbreak. Whole-genome sequencing (WGS) analysis was performed on 9 clinical isolates obtained from 8 patients, and the results were compared to clinical and epidemiological records. All isolates were ST11 CP-Kp. Single-nucleotide polymorphisms and the presence and structure of plasmids indicated that this CP-Kp outbreak had different origins. These 9 isolates were partitioned into two clades according to genetic distance. Four plasmids, CP002474.1, CP006799.1, CP018455.1, and CP025459.1, were detected among the 9 isolates. The plasmid phylogeny and antibiotic resistance (AR) gene profile results were consistent with the sequencing results. We found that two clades of CP-Kp were responsible for this nosocomial outbreak and demonstrated the transmission route from two index patients. Plasmid carriage and phylogeny are a useful tool for identifying clades involved in disease transmission.
Highlights
Carbapenem-producing Klebsiella pneumoniae (CP-Kp) refers to K. pneumoniae which is resistant to carbapenem with acquired carbapenemases
The carbapenem-producing Klebsiella pneumoniae (CP-Kp) outbreak occurred in a new infectious disease care unit (IDCU), a 5-ward (17 beds) intensive care center, which was operational only for 2 months
After a 24-h stay in the emergency room, he was transferred to an isolation ward of the IDCU after being diagnosed with H7N9 influenza A infection by traditional PCR
Summary
Carbapenem-producing Klebsiella pneumoniae (CP-Kp) refers to K. pneumoniae which is resistant to carbapenem with acquired carbapenemases. Despite commensal colonization in the respiratory tract, gastrointestinal tract, and skin, among other locations, K. pneumoniae is a typical nosocomial pathogen that causes high mortality. CP-Kp is a major concern for nosocomial infections worldwide. Infections caused by this pathogen are difficult to treat because CP-Kp is resistant to a wide variety of antibiotics, including carbapenems and colistin (Munoz-Price et al, 2013; Liu et al, 2016), which are last-resort drugs used in clinical practice. K. pneumoniae carbapenemases (KPCs) were first identified in the United States in 1996 (Munoz-Price et al, 2013).
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