title: Outbreak of KPC-2-producing Enterobacteriaceae caused by clonal dissemination of Klebsiella pneumoniae ST307 carrying an IncX3-type plasmid harboring a truncated Tn4401a.
abstract: Over a 5-month period between the end of June and the beginning of November in 2015, a KPC-producing Enterobacteriaceae outbreak occurred in a general hospital in Busan, South Korea, being associated with a total of 50 clinical isolates from 47 patients. Multilocus sequence typing and pulsed-field gel electrophoresis were carried out for strain typing and whole-genome sequencing was performed to characterize the plasmids. A clonal spread of K. pneumoniae sequence type 307 (ST307) carrying a self-transferable IncX3-type plasmid harboring blaKPC-2was responsible for the outbreak. Sporadic emergence of K. pneumoniae ST697 carrying an IncFII-type plasmid and a ST11 isolate harboring a small plasmid devoid of any known origin of replication were observed to be associated with blaKPC-3, but no further dissemination of these strains was identified. The results indicated a healthcare-associated infection associated with a blaKPC-harboring plasmid dissemination and a clonal spread of KPC-producing Enterobacteriaceae.
authors.affiliation: Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Jung Ok
authors.initials: JO
authors.lastname: Kim
authors.affiliation: Department of Laboratory Medicine, Inje University College of Medicine, Busan, South Korea.
authors.forename: Sae Am
authors.initials: SA
authors.lastname: Song
authors.affiliation: Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Eun-Jeong
authors.initials: EJ
authors.lastname: Yoon
authors.affiliation: Department of Laboratory Medicine, Inje University College of Medicine, Busan, South Korea.
authors.forename: Jeong Hwan
authors.initials: JH
authors.lastname: Shin
authors.affiliation: Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Hyukmin
authors.initials: H
authors.lastname: Lee
authors.affiliation: Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: kscpjsh@yuhs.ac.
authors.forename: Seok Hoon
authors.initials: SH
authors.lastname: Jeong
authors.affiliation: Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul, South Korea.
authors.forename: Kyungwon
authors.initials: K
authors.lastname: Lee
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics; D003428:Cross Infection / Q000382:microbiology; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field / Q000379:methods; D004755:Enterobacteriaceae / Q000235:genetics / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000382:microbiology*; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000235:genetics / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests / Q000379:methods; D017720:Molecular Epidemiology / Q000379:methods; D058885:Multilocus Sequence Typing / Q000379:methods; D010957:Plasmids / Q000235:genetics*; D056910:Republic of Korea; D017422:Sequence Analysis, DNA / Q000379:methods; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001426:Bacterial Proteins; C491478:beta-lactamase KPC-2; D001618:beta-Lactamases
keywords: Carbapenem resistance; IncX3; Klebsiella pneumoniae; ST307; Tn4401a; bla(KPC)