Abstract
BackgroundCarbapenem-resistant Klebsiella pneumoniae (CRKP) is a major cause of nosocomial infections worldwide. The transmission route of CRKP isolates within an outbreak is rarely described. This study aimed to reveal the molecular characteristics and transmission route of CRKP isolates within an outbreak of nosocomial infection.MethodsCollecting case information, active screening and targeted environmental monitoring were carried out. The antibiotic susceptibility, drug-resistant genes, molecular subtype and whole genome sequence of CRKP strains were analyzed.ResultsBetween October and December 2011, 26 CRKP isolates were collected from eight patients in a surgical intensive care unit and subsequent transfer wards of Beijing Tongren hospital, China. All 26 isolates harbored blaKPC-2, blaSHV-1, and blaCTX-M-15 genes, had the same or similar pulsed-field gel electrophoresis patterns, and belonged to the sequence type 11 (ST11) clone. By comprehensive consideration of genomic and epidemiological information, a putative transmission map was constructed, including identifying one case as an independent event distinct from the other seven cases, and revealing two transmissions starting from the same case.ConclusionsThis study provided the first report confirming an outbreak caused by K. pneumoniae ST11 clone co-harboring the blaKPC-2, blaCTX-M-15, and blaSHV-1 genes, and suggested that comprehensive consideration of genomic and epidemiological data can yield a fine transmission map of an outbreak and facilitate the control of nosocomial transmission.
Highlights
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a major cause of nosocomial infections worldwide
Outbreak descriptions The outbreak occurred in the surgical intensive care unit (SICU) of Beijing Tongren Hospital, a 1600-bed general tertiary care and university-affiliated teaching hospital in Beijing, China
Between October 8 and December 23, a total of 50 patients were admitted into the SICU and eight of them were found to have a CRKP infection or colonization though routine clinical culture and active screening (Table 1)
Summary
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a major cause of nosocomial infections worldwide. Since the first KPC-producing isolate was identified from North Carolina, USA, in 1996 [7], the occurrence of KPC-producing bacteria has been continuously reported in other parts of the USA, Europe, South America, the Middle East, and Asia [5, 8,9,10] They have been associated with large nosocomial outbreaks worldwide, including those in China. KPC-producing members of the family Enterobacteriaceae have been associated with high mortality rates, among critically ill patients with a history of prolonged hospitalization [19,20,21] These facts strongly suggest a need for the implementation of adequate preventive measures to effectively control the spread of such pathogens
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