title: Nosocomial Outbreak of OXA-48-Producing Klebsiella pneumoniae in a Chinese Hospital: Clonal Transmission of ST147 and ST383.
abstract: BACKGROUND
  In China, the spread and outbreak of OXA-48-producing Enterobacteriaceae remains largely unknown.
  
  
  METHODS
  OXA-48-producing isolates were analyzed for genetic relatedness by pulsed-field gel electrophoresis (PFGE), antimicrobial susceptibility by E-test, and sequence type (ST) by multilocus sequence typing. S1-PFGE and southern blotting were used for plasmid profiling, and PCR and subsequent sequencing were performed to determine the genetic environment of blaOXA-48 gene.
  
  
  RESULTS
  In total, 37 non-duplicated OXA-48-producing K. pneumoniae (OXAKp) isolates were recovered. From December 2013 to August 2014, an outbreak was observed at a respiratory ICU. The 37 isolates of K. pneumoniae were categorized into four PFGE types (A, B, C, and D). The predominant strains associated with the outbreak were strains with PFGE type A and B, which belonged to ST383 and ST147, respectively. Plasmid sequencing revealed that the blaOXA-48-carrying plasmid is 69,069 bp in length and belongs to the IncL/M incompatibility group. Sequence analysis revealed that the IS1999 element was located upstream of the blaOXA-48 gene and was truncated by IS1R.
  
  
  CONCLUSIONS
  In this study, the dissemination and outbreak of OXAKp isolates were clonal, and ST147 and ST383 K. pneumoniae were the predominant clones that were associated with the outbreak. Meanwhile, the horizontal transfer of plasmids potentially mediate the spread of blaOXA-48 gene between different K. pneumoniae strains.
authors.affiliation: Department of Microbiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Ling
authors.initials: L
authors.lastname: Guo
authors.affiliation: Department of Microbiology, Chinese PLA General Hospital, Beijing, China.|Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Jingna
authors.initials: J
authors.lastname: An
authors.affiliation: Department of Microbiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Yanning
authors.initials: Y
authors.lastname: Ma
authors.affiliation: Department of Microbiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Liyan
authors.initials: L
authors.lastname: Ye
authors.affiliation: Department of Microbiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Yanping
authors.initials: Y
authors.lastname: Luo
authors.affiliation: Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.
authors.forename: Chuanmin
authors.initials: C
authors.lastname: Tao
authors.affiliation: Department of Microbiology, Chinese PLA General Hospital, Beijing, China.
authors.forename: Jiyong
authors.initials: J
authors.lastname: Yang
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques; D002681:China / Q000453:epidemiology; D004269:DNA, Bacterial / Q000737:chemistry / Q000302:isolation & purification / Q000378:metabolism; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D006761:Hospitals; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000235:genetics / Q000378:metabolism*; D008826:Microbial Sensitivity Tests; D010957:Plasmids / Q000235:genetics / Q000378:metabolism; D018272:Porins / Q000235:genetics; D017422:Sequence Analysis, DNA; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial; C092233:OmpK36 protein, Klebsiella pneumoniae; D018272:Porins; C456080:beta-lactamase CTX-M-14; C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases; C108449:oxacillinase