title: An Outbreak of Infections Caused by a Klebsiella pneumoniae ST11 Clone Coproducing Klebsiella pneumoniae Carbapenemase-2 and RmtB in a Chinese Teaching Hospital.
abstract: BACKGROUND
  Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae bacteria, which cause serious disease outbreaks worldwide, was rarely detected in Xiangya Hospital, prior to an outbreak that occurred from August 4, 2014, to March 17, 2015. The aim of this study was to analyze the epidemiology and molecular characteristics of the K. pneumoniae strains isolated during the outbreak.
  
  
  METHODS
  Nonduplicate carbapenem-resistant K. pneumoniae isolates were screened for blaKPC-2and multiple other resistance determinants using polymerase chain reaction. Subsequent studies included pulsed-field gel electrophoresis (PFGE), multilocus sequence typing, analysis of plasmids, and genetic organization of blaKPC-2locus.
  
  
  RESULTS
  Seventeen blaKPC-2-positive K. pneumoniae were identified. A wide range of resistant determinants was detected. Most isolates (88.2%) coharbored blaKPC-2and rmtB in addition to other resistance genes, including blaSHV-1, blaTEM-1, and aac(3)-IIa. The blaKPC-2and rmtB genes were located on the conjugative IncFIB-type plasmid. Genetic organization of blaKPC-2locusin most strains was consistent with that of the plasmid pKP048. Four types (A1, A2, A3, and B) were detected by PFGE, and Type A1, an ST11, was the predominant PFGE type. A novel K. pneumoniae sequence type (ST1883) related to ST11 was discovered.
  
  
  CONCLUSIONS
  These isolates in our study appeared to be clonal and ST11 K. pneumoniae was the predominant clone attributed to the outbreak. Coharbing of blaKPC-2and rmtB, which were located on a transferable plasmid, in clinical K. pneumoniae isolates may lead to the emergence of a new pattern of drug resistance.
authors: Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
authors: Jun
authors: J
authors: Li
authors: Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
authors: Ming-Xiang
authors: MX
authors: Zou
authors: Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
authors: Hai-Chen
authors: HC
authors: Wang
authors: Department of Infection Control Center, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
authors: Qing-Ya
authors: QY
authors: Dou
authors: Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
authors: Yong-Mei
authors: YM
authors: Hu
authors: Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
authors: Qun
authors: Q
authors: Yan
authors: Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China.
authors: Wen-En
authors: WE
authors: Liu
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000378:metabolism*; D002681:China; D016521:Electrophoresis, Gel, Pulsed-Field; D006784:Hospitals, Teaching; D007710:Klebsiella Infections / Q000209:etiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000378:metabolism*; D008780:Methyltransferases / Q000378:metabolism*; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D008780:Methyltransferases; D001618:beta-Lactamases; C531581:carbapenemase-2, Klebsiella pneumoniae