title: High Prevalence of ESBL-ProducingKlebsiella pneumoniaeCausing Community-Onset Infections in China.
abstract: The aim of this work was to investigate the epidemiological and genetic characteristics of ESBL-producingKlebsiella pneumoniae(ESBL-Kp) causing community-onset infections.K. pneumoniaeisolates were collected from 31 Chinese secondary hospitals between August 2010 and 2011. Genes encoding ESBL and AmpC beta-lactamases were detected by PCR. The isolates were assigned to sequence types (STs) using multi-locus sequence typing (MLST). Eleven ESBL-Kp strains were selected for whole-genome sequencing (WGS) for investigating the genetic environment and plasmids encoding ESBL genes. A total of 578K. pneumoniaeisolates were collected, and 184 (31.8%) carried ESBL genes. The prevalence of ESBL-Kp varied from different geographical areas of China (10.2-50.3%). The three most prevalent ESBL genes wereblaCTX-M-14(n= 74),blaCTX-M-15(n= 60), andblaCTX-M-3(n= 40). MLST assigned 127 CTX-M-14 and CTX-M-15 producers to 54 STs, and CC17 was the most prevalent population (12.6%). STs (23, 37, and 86) that were known frequently associated with hypervirulentK. pneumoniae(hvKP) account for 14.1% (18/127). Phylogenetic analysis by concatenating the seven loci of MLST revealed the existence of ESBL-producingK. quasipneumoniae(two strains) andK. varricola(one strain), which was further confirmed by WGS. This study highlights the challenge of community-onset infections caused by ESBL-Kp in China. The prevalence of STs frequently associating with hvKP should be of concern. Surveillance of ESBL-KP causing community-onset infections now appears imperative.
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China; Department of Respiratory Disease, The First Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China.
authors.forename: Kai
authors.initials: K
authors.lastname: Zhou
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China.
authors.forename: Beiwen
authors.initials: B
authors.lastname: Zheng
authors.affiliation: Department of Clinical Laboratory, The First Affiliated Hospital of Soochow University Soochow, China.
authors.forename: Lina
authors.initials: L
authors.lastname: Zhao
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China.
authors.forename: Ping
authors.initials: P
authors.lastname: Shen
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China.
authors.forename: Jinru
authors.initials: J
authors.lastname: Ji
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China.
authors.forename: Zeqing
authors.initials: Z
authors.lastname: Wei
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China.
authors.forename: Lanjuan
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Respiratory Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China.
authors.forename: Jianying
authors.initials: J
authors.lastname: Zhou
authors.affiliation: Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, State Key Laboratory for Diagnosis and Treatment of Infectious Disease, The First Affiliated Hospital, School of Medicine, Zhejiang University Hangzhou, China.
authors.forename: Yonghong
authors.initials: Y
authors.lastname: Xiao
keywords: CTX-M; community-onset infections; hypervirulent K. pneumoniae; resistance mechanisms; sequence type