title: Molecular epidemiology of extensively drug-resistant Klebsiella pneumoniae outbreak in Wenzhou, Southern China.
abstract: The emergence of extensively drug-resistant (XDR) Klebsiella pneumoniae has become a major challenge worldwide. In this study, we characterized the phenotypes and genetic features of nine XDR K. pneumoniae isolates from an integrated hospital in Zhejiang province, China, from September to October 2014. These XDR K. pneumoniae possessed at least five resistance determinants which contribute to highly resistant to β-lactam, β-lactam/inhibitor combinations, aminoglycosides, quinolones, carbapenems, chloroamphenicol and fosfomycin. All isolates carried blaKPC-2, blaCTX-M-9, blaSHV-11 and rmtB, and several isolates also harboured blaTEM-1 and qnrS. Southern blot experiments confirmed that blaKPC-2, rmtB and blaCTX-M-9 were located on the same ~54.2 kb plasmid. Conjugative plasmids were obtained from all K. pneumoniae isolates, further proving the transferable characteristic of the resistance determinants. The OmpK36 sequences showed various deletions and insertions that indicated additional amino acid residues and a deleted phenotype of OmpK36. PFGE demonstrated that all the isolates belonged to the same genotype. Multilocus sequence typing was concordant with PFGE results and revealed that ST11 was the most predominant clone. Our study revealed a high incidence and endemic spread of XDR K. pneumoniae in the hospital. Thus, effective infection control measures should be adopted to monitor and control the spread of multidrug-resistant isolates.
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China.
authors.forename: Jia
authors.initials: J
authors.lastname: Du
authors.affiliation: School of Medical Lab Science, Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China.
authors.forename: Jianming
authors.initials: J
authors.lastname: Cao
authors.affiliation: Wenzhou Hospital of Integrated Traditional Chinese and Western Medicine, Wenzhou, Zhejiang Province, PR China.
authors.forename: Lizhen
authors.initials: L
authors.lastname: Shen
authors.affiliation: School of Medical Lab Science, Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China.
authors.forename: Wenzi
authors.initials: W
authors.lastname: Bi
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China.
authors.forename: Xiaoxiao
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China.
authors.forename: Haiyang
authors.initials: H
authors.lastname: Liu
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China.
authors.forename: Hong
authors.initials: H
authors.lastname: Lu
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang Province, PR China.
authors.forename: Tieli
authors.initials: T
authors.lastname: Zhou
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics* / Q000302:isolation & purification; D008297:Male; D017720:Molecular Epidemiology; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases