title: Infections caused by OXA-48-producing Klebsiella pneumoniae in a tertiary hospital in Spain in the setting of a prolonged, hospital-wide outbreak.
abstract: OBJECTIVE
  We describe clinical and microbiological features of infections caused by OXA-48-producing Klebsiella pneumoniae (O48KP) in the setting of a prolonged, hospital-wide outbreak detected in January 2011.
  
  
  METHODS
  Clinical, demographic and microbiological data of patients with growth of O48KP in clinical specimens were collected until December 2011. PCR was used to detect carbapenemase and β-lactamase genes. The genetic relationships were determined by automated repetitive-sequence-based PCR.
  
  
  RESULTS
  Seventy-one patients with clinically guided cultures showing growth of O48KP were identified. Nine were considered to be colonizing rather than causing infection. The most frequent source of infection was the urinary tract (22/62), followed by surgical site infections (17/62). Blood cultures were positive in 23/62 patients. Many patients had significant comorbidity and prolonged hospital stays. In-hospital mortality among patients with O48KP infections was 43.5%. The MIC(90)s of ertapenem, imipenem and meropenem were >32, 16 and 16 mg/L, respectively. No single antimicrobial was active against all the isolates. The antibiotics most active against O48KP were amikacin (97.2% susceptible), colistin (90.1%), tigecycline (73%) and fosfomycin (66.2%). Although eight clones were identified, a predominant clone caused 73.2% of the infections. Multilocus sequence typing (MLST) of the predominant clone gave sequence type (ST) 405 and bla(TEM-1), bla(SHV-76), bla(CTX-M-15) and bla(OXA-1) genes and the insertion sequence IS1999 of the Tn1999 transposon were associated with bla(OXA-48) in this clone.
  
  
  CONCLUSIONS
  To our knowledge, this is the largest reported series of infections caused by O48KP in the setting of a single-centre outbreak and provides further input on the clinical relevance of infections caused by O48KP and the difficulties associated with its detection and control.
authors.affiliation: Infectious Diseases and Clinical Microbiology Unit, Hospital Universitario La Paz-IDIPAZ, Madrid, Spain. jrpano.hulp@salud.madrid.org
authors.forename: José Ramón
authors.initials: JR
authors.lastname: Paño-Pardo
authors.forename: Guillermo
authors.initials: G
authors.lastname: Ruiz-Carrascoso
authors.forename: Carolina
authors.initials: C
authors.lastname: Navarro-San Francisco
authors.forename: Rosa
authors.initials: R
authors.lastname: Gómez-Gil
authors.forename: Marta
authors.initials: M
authors.lastname: Mora-Rillo
authors.forename: María Pilar
authors.initials: MP
authors.lastname: Romero-Gómez
authors.forename: Natalia
authors.initials: N
authors.lastname: Fernández-Romero
authors.forename: Julio
authors.initials: J
authors.lastname: García-Rodríguez
authors.forename: Verónica
authors.initials: V
authors.lastname: Pérez-Blanco
authors.forename: Francisco
authors.initials: F
authors.lastname: Moreno-Ramos
authors.forename: Jesús
authors.initials: J
authors.lastname: Mingorance
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology* / Q000235:genetics; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000235:genetics; D007711:Klebsiella pneumoniae / Q000235:genetics / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D013030:Spain / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000639:trends; D013997:Time Factors; D055815:Young Adult; D001618:beta-Lactamases / Q000235:genetics* / Q000302:isolation & purification
chemical_list: D001618:beta-Lactamases; C108449:oxacillinase