title: An outbreak of infections caused by extensively drug-resistant Klebsiella pneumoniae strains during a short period of time in a Chinese teaching hospital: epidemiology study and molecular characteristics.
abstract: In this study, we comprehensively described the clinical risk factors, outcome, epidemiology, and molecular basis associated with an outbreak of extensively drug-resistant KPC-2-producing Klebsiella pneumoniae involving 15 patients in a teaching hospital from May 1 to June 27, 2013. Most of the patients were elderly and received long-term hospital treatment, and 40.0% (6/15) of them were dead. All strains carried bla(KPC-2), rmtB, bla(CTX-M-65), bla(SHV-11), oqxA, oqxB, and aac(6')-Ib-cr and even harbored additional other resistance genes, such as armA, bla(CTX-M-1), bla(TEM-1). bla(KPC-2), rmtB, and bla(CTX-M-65) were located on the same ~54.2-kb plasmid, and conjugation experiments further proved the cotransferable characteristic. Alterations of outer membrane proteins were confirmed by sodium dodecyl sulfate--olyacrylamide gelelectrophoresis and sequencing, which can lead to a drastic change in the permeability of cells. All isolates belonged to the clone complex 258, spreading rapidly across the world. Our study demonstrated that a high degree of awareness and surveillance of those drug resistance determinants is urgently needed.
authors: Department of Microbiology and Immunology, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China; Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China.
authors: Tieli
authors: T
authors: Zhou
authors: Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China.
authors: Yapei
authors: Y
authors: Zhang
authors: Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China.
authors: Meimei
authors: M
authors: Li
authors: School of Laboratory Medicine and life Science, Wenzhou Medical University, Wenzhou, Zhejiang Province, China.
authors: Xiao
authors: X
authors: Yu
authors: Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, 325035, China.
authors: Yao
authors: Y
authors: Sun
authors: Department of Microbiology and Immunology, School of Medicine, Xi'an Jiaotong University, Xi'an, Shaanxi, 710061, China. Electronic address: xujiru@mail.xjtu.edu.cn.
authors: Jiru
authors: J
authors: Xu
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D016000:Cluster Analysis; D003227:Conjugation, Genetic; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D004591:Electrophoresis, Polyacrylamide Gel; D005260:Female; D022761:Gene Transfer, Horizontal; D005798:Genes, Bacterial; D006784:Hospitals, Teaching; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D008297:Male; D026901:Membrane Transport Proteins / Q000032:analysis; D008875:Middle Aged; D058889:Molecular Typing; D010957:Plasmids / Q000032:analysis; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D016019:Survival Analysis; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D026901:Membrane Transport Proteins; C491478:beta-lactamase KPC-2; D001618:beta-Lactamases
keywords: 16S rRNA methylase; KPC-2; Klebsiella pneumoniae; ST11; Southern hybridization; XDR