title: A carbapenem-resistant Klebsiella pneumoniae epidemic clone in Jerusalem: sequence type 512 carrying a plasmid encoding aac(6')-Ib.
abstract: OBJECTIVE
  We characterized distinctive features of a hypertransmissible carbapenem-resistant Klebsiella pneumoniae (CRKP) clone that emerged at Hadassah Hospital, Ein-Kerem, Jerusalem, Israel, in 2006.
  
  
  METHODS
  Eleven CRKP isolated at Hadassah Hospital during 2005-09 were examined by antimicrobial susceptibility testing, PFGE and multilocus sequence typing (MLST). Plasmids were analysed by conjugation, restriction mapping, PCR and sequencing.
  
  
  RESULTS
  Divergence from the national epidemic sequence type (ST) ST258 to ST512 was observed early on. Carbapenem resistance was conferred by bla(KPC-3) carried on a plasmid apparently closely related to pKpQIL, also from Israel. This clone also carried a 15 kb plasmid, designated pAAC154, that carries a Tn1331 derivative containing the aac(6')-Ib gene. pAAC154 does not carry a bla(KPC) gene, but is similar to pS15, a plasmid from New York that carries bla(KPC-2).
  
  
  CONCLUSIONS
  A single CRKP clone ST512 has spread efficiently in our region. In this clone, aac(6')-Ib, common in CRKP strains, is carried on a different plasmid from bla(KPC-3).
authors.affiliation: Department of Clinical Microbiology and Infectious Diseases,  Hadassah-Hebrew University, Jerusalem, 91120,  Israel.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Warburg
authors.forename: Carlos
authors.initials: C
authors.lastname: Hidalgo-Grass
authors.forename: Sally R
authors.initials: SR
authors.lastname: Partridge
authors.forename: Marcelo E
authors.initials: ME
authors.lastname: Tolmasky
authors.forename: Violeta
authors.initials: V
authors.lastname: Temper
authors.forename: Allon E
authors.initials: AE
authors.lastname: Moses
authors.forename: Colin
authors.initials: C
authors.lastname: Block
authors.forename: Jacob
authors.initials: J
authors.lastname: Strahilevitz
mesh_terms: D000123:Acetyltransferases / Q000235:genetics*; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005838:Genotype; D006761:Hospitals; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D058885:Multilocus Sequence Typing; D010957:Plasmids; D016133:Polymerase Chain Reaction; D015183:Restriction Mapping; D017422:Sequence Analysis, DNA; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; D004269:DNA, Bacterial; D000123:Acetyltransferases; C056532:aminoglycoside N(6')-acetyltransferase