Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing.
The Gram-negative bacteria Klebsiella pneumoniae is a major cause of nosocomial infections, primarily among immunocompromised patients. The emergence of strains resistant to carbapenems has left few treatment options, making infection containment critical. In 2011, the U.S. National Institutes of Health Clinical Center experienced an outbreak of carbapenem-resistant K. pneumoniae that affected 18 patients, 11 of whom died. Whole-genome sequencing was performed on K. pneumoniae isolates to gain insight into why the outbreak progressed despite early implementation of infection control procedures. Integrated genomic and epidemiological analysis traced the outbreak to three independent transmissions from a single patient who was discharged 3 weeks before the next case became clinically apparent. Additional genomic comparisons provided evidence for unexpected transmission routes, with subsequent mining of epidemiological data pointing to possible explanations for these transmissions. Our analysis demonstrates that integration of genomic and epidemiological data can yield actionable insights and facilitate the control of nosocomial transmission.
National Human Genome Research Institute, Bethesda, MD 20892, USA.
Evan S
ES
Snitkin
Adrian M
AM
Zelazny
Pamela J
PJ
Thomas
Frida
F
Stock
David K
DK
Henderson
Tara N
TN
Palmore
Julia A
JA
Segre
D000328:Adult; D000368:Aged; D015780:Carbapenems / Q000494:pharmacology*; D003091:Colistin / Q000494:pharmacology; D016358:Contact Tracing; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D024881:Drug Resistance, Bacterial / Q000187:drug effects / Q000235:genetics*; D005260:Female; D016680:Genome, Bacterial / Q000235:genetics*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D008969:Molecular Sequence Data; D009154:Mutation / Q000235:genetics; D020641:Polymorphism, Single Nucleotide / Q000235:genetics; D017422:Sequence Analysis, DNA / Q000379:methods*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
D015780:Carbapenems; D003091:Colistin