title: Large Nosocomial Outbreak of Colistin-Resistant, Carbapenemase-Producing Klebsiella pneumoniae Traced to Clonal Expansion of an mgrB Deletion Mutant.
abstract: We describe a large hospital outbreak (93 bloodstream infections) of colistin-resistant Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae isolates which was mirrored by increased colistin consumption. The outbreak was mostly traced to the clonal expansion of an mgrB deletion mutant of an ST512 strain that produced KPC-3.
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Giani
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Arena
authors.affiliation: Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.
authors.forename: Guendalina
authors.initials: G
authors.lastname: Vaggelli
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy.
authors.forename: Viola
authors.initials: V
authors.lastname: Conte
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Chiarelli
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Henrici De Angelis
authors.affiliation: Hospital Pharmacy Unit, Florence Careggi University Hospital, Florence, Italy.
authors.forename: Rossella
authors.initials: R
authors.lastname: Fornaini
authors.affiliation: Hospital Medical Direction, Florence Careggi University Hospital, Florence, Italy.
authors.forename: Maddalena
authors.initials: M
authors.lastname: Grazzini
authors.affiliation: Hospital Medical Direction, Florence Careggi University Hospital, Florence, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Niccolini
authors.affiliation: Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.
authors.forename: Patrizia
authors.initials: P
authors.lastname: Pecile
authors.affiliation: Department of Medical Biotechnologies, University of Siena, Siena, Italy Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy Don Carlo Gnocchi Foundation, Florence, Italy gianmaria.rossolini@unifi.it.
authors.forename: Gian Maria
authors.initials: GM
authors.lastname: Rossolini
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D003091:Colistin / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005838:Genotype; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D058889:Molecular Typing; D017384:Sequence Deletion; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase; D003091:Colistin