title: Use of whole-genome sequencing to trace, control and characterize the regional expansion of extended-spectrum β-lactamase producing ST15 Klebsiella pneumoniae.
abstract: The study describes the transmission of a CTX-M-15-producing ST15 Klebsiella pneumoniae between patients treated in a single center and the subsequent inter-institutional spread by patient referral occurring between May 2012 and September 2013. A suspected epidemiological link between clinical K. pneumoniae isolates was supported by patient contact tracing and genomic phylogenetic analysis from May to November 2012. By May 2013, a patient treated in three institutions in two cities was involved in an expanding cluster caused by this high-risk clone (HiRiC) (local expansion, CTX-M-15 producing, and containing hypervirulence factors). A clone-specific multiplex PCR was developed for patient screening by which another patient was identified in September 2013. Genomic phylogenetic analysis including published ST15 genomes revealed a close homology with isolates previously found in the USA. Environmental contamination and lack of consistent patient screening were identified as being responsible for the clone dissemination. The investigation addresses the advantages of whole-genome sequencing in the early detection of HiRiC with a high propensity of nosocomial transmission and prolonged circulation in the regional patient population. Our study suggests the necessity for inter-institutional/regional collaboration for infection/outbreak management of K. pneumoniae HiRiCs.
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.|State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medicine School, Zhejiang University, China.
authors: Kai
authors: K
authors: Zhou
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors: Mariette
authors: M
authors: Lokate
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors: Ruud H
authors: RH
authors: Deurenberg
authors: Department of Rehabilitation Medicine, Center for Rehabilitation, University of Groningen, University Medical Center Groningen, Netherlands.
authors: Marga
authors: M
authors: Tepper
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors: Jan P
authors: JP
authors: Arends
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors: Erwin G C
authors: EG
authors: Raangs
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors: Jerome
authors: J
authors: Lo-Ten-Foe
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors: Hajo
authors: H
authors: Grundmann
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors: John W A
authors: JW
authors: Rossen
authors: Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
authors: Alexander W
authors: AW
authors: Friedrich
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015373:Bacterial Typing Techniques; D002999:Clone Cells; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000635:transmission; D004196:Disease Outbreaks; D015870:Gene Expression; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification / Q000472:pathogenicity*; D060885:Multiplex Polymerase Chain Reaction; D009426:Netherlands / Q000453:epidemiology; D010355:Patient Identification Systems; D062486:Public Health Surveillance; D014774:Virulence; D018440:beta-Lactam Resistance / Q000235:genetics; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D047090:beta-Lactams; C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases