title: Dissemination and clinical implications of multidrug-resistant Klebsiella pneumoniae isolates producing OXA-48 in a Spanish hospital.
abstract: BACKGROUND
  Healthcare-associated infections caused by Klebsiella pneumoniae isolates are increasing and few effective antibiotics are currently available to treat patients.
  
  
  OBJECTIVE
  To assess the epidemiology, molecular basis, clinical features, and outcomes in the acquisition and dissemination of OXA-48-producing K. pneumoniae (OXA48KP) in a tertiary Spanish hospital between October 2013 and December 2015.
  
  
  METHODS
  Clinical, demographic, and microbiological data of patients with OXA48KP in clinical samples were collected from medical records. Carbapenemase genes were detected by polymerase chain reaction. Genetic relationships were determined by pulsed-field gel electrophoresis and multi-locus sequence typing.
  
  
  RESULTS
  In all, 116 episodes of OXA48KP in clinical samples were identified. The most frequent types of infection were urinary tract (N = 43, 42%), secondary bloodstream (N = 18, 17%), and surgical site infection (N = 17, 17%). More than one-quarter (28%) of infected patients died in hospital. Among infected patients (N = 90, 78%), infections were mainly classified as hospital-acquired (N = 70, 88%). A high number of OXA48KP isolates showed multidrug resistance, with highest susceptibility to colistin (86%), gentamicin (69%) and amikacin (59%). Most (87%) isolates were included in a main cluster. Seven (N = 8, 88%) isolates showed an identical allelic profile, associated with ST15. Only the isolate from cluster P8 was associated with ST29. The results confirm high dissemination of OXA48KP in our hospital due to the main clone ST15. OXA48KP infection was associated with a high mortality and was mainly hospital-acquired.
  
  
  CONCLUSIONS
  This study highlights the importance of active surveillance programmes, especially those focusing on hospital readmissions in order to control the spread of carbapenemase-producing Enterobacteriaceae.
authors.affiliation: Department of Microbiology and Infection Control, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain. Electronic address: ana_madueno@hotmail.com.
authors.forename: A
authors.initials: A
authors.lastname: Madueño
authors.affiliation: Department of Hospital Pharmacy, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain.
authors.forename: J
authors.initials: J
authors.lastname: González García
authors.affiliation: Laboratory of Reference and Research in Resistance to Antibiotics and Infections Related to Health Care, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Spain.
authors.forename: S
authors.initials: S
authors.lastname: Fernández-Romero
authors.affiliation: Laboratory of Reference and Research in Resistance to Antibiotics and Infections Related to Health Care, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Oteo
authors.affiliation: Department of Microbiology and Infection Control, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, Spain; Department of Preventive Medicine and Public Health, Universidad de la Laguna, La Laguna, Santa Cruz de Tenerife, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Lecuona
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D058885:Multilocus Sequence Typing; D016133:Polymerase Chain Reaction; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D016019:Survival Analysis; D062606:Tertiary Care Centers; D001618:beta-Lactamases / Q000032:analysis* / Q000235:genetics
chemical_list: D001618:beta-Lactamases; C108449:oxacillinase
keywords: Epidemiology; Infection; Klebsiella pneumoniae; OXA-48