title: Molecular epidemiology of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae in different facilities in Southern Brazil.
abstract: BACKGROUND
  Klebsiella pneumoniae carbapenemase-producing K pneumoniae (KPC-KP) outbreaks have been reported in many countries, including Brazil. The incidence of KPC-KP infection has increased in the first semester of 2011 in Curitiba, the capital of Parana, in Southern Brazil.The aim of this study was to characterize the infections and clonal diversity of KPC-KP isolates from several institutions in Curitiba.
  
  
  METHODS
  KPC-KP from several clinical samples and rectal swabs taken between April 2010 and July 2012 were included. One isolate per patient was evaluated. All isolates were submitted to polymerase chain reaction (PCR) for blaKPC. The genetic relatedness was evaluated using strain clustering by an automated repetitive extragenic palindromic (rep) PCR-based typing system.
  
  
  RESULTS
  There were 641 samples that were positive for K pneumoniae carbapenemase-2 carbapenemase. There were 129 samples randomly selected for clonality evaluation. PCR and strain clustering by the automated rep PCR-based typing system identified 7 clones (A-C and E-H). Clone E was identified in only 1 hospital, and all other clones were found in >2 hospitals. Clones C and G were the most disseminated among hospitals. The infection and colonization occurred in 14 out of the 32 main hospitals in town. Similar clones were found in 2 hospitals that are administered by the same group. Another clone (H) was found in 2 hospitals receiving patients from the same municipal emergency unit.
  
  
  CONCLUSIONS
  The KPC-KP outbreak in Curitiba is polyclonal, and the source is unknown. Some hospitals share the same clones.
authors.affiliation: Division of Infectious Diseases, Universidade Federal do Parana, Curitiba, PR, Brazil; Bacteriology Section, Laboratório Central de Saúde Pública do Estado Laboratorio Central-PR, Sao Jose do Pinhais, PR, Brazil.
authors.forename: Lavinia N
authors.initials: LN
authors.lastname: Arend
authors.affiliation: Medicine Department, Universidade Estadual de Ponta Grossa, Ponta Grossa, PR, Brazil; Epidemiologic Surveillance Center, Secretaria Municipal de Saúde de Curitiba, Curitiba, PR, Brazil.
authors.forename: Paula
authors.initials: P
authors.lastname: Toledo
authors.affiliation: Division of Infectious Diseases, Universidade Federal do Parana, Curitiba, PR, Brazil; Microbiology Department, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Pilonetto
authors.affiliation: Division of Infectious Diseases, Universidade Federal do Parana, Curitiba, PR, Brazil. Electronic address: flptuon@gmail.com.
authors.forename: Felipe F
authors.initials: FF
authors.lastname: Tuon
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000145:classification / Q000235:genetics / Q000378:metabolism*; D001938:Brazil; D024881:Drug Resistance, Bacterial; D015964:Gene Expression Regulation, Bacterial / Q000502:physiology*; D015971:Gene Expression Regulation, Enzymologic / Q000502:physiology*; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000235:genetics / Q000378:metabolism; D017720:Molecular Epidemiology; D001618:beta-Lactamases / Q000145:classification / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Brazil; Carbapenems; Klebsiella pneumoniae; Klebsiella pneumoniae carbapenemase; Molecular epidemiology