期刊
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
卷 61, 期 2, 页码 -出版社
AMER SOC MICROBIOLOGY
DOI: 10.1128/AAC.01516-16
关键词
carbapenem-resistant Enterobacteriaceae (CRE); Klebsiella pneumoniae carbapenemase (KPC); outbreak; health care-associated infection; whole-genome sequencing; burn patients
资金
- UNC Health Care
- Japan Society for the Promotion of Science (JSPS) Postdoctoral Fellowship for Research Abroad
- UNC School of Medicine
- [F30 AI109979]
- [T32 GM008719]
Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae has been recently recognized in the United States. Whole-genome sequencing (WGS) has become a useful tool for analysis of outbreaks and for determining transmission networks of multidrug-resistant organisms in health care settings, including carbapenem-resistant Enterobacteriaceae (CRE). We experienced a prolonged outbreak of CRE E. cloacae and K. pneumoniae over a 3-year period at a large academic burn center despite rigorous infection control measures. To understand the molecular mechanisms that sustained this outbreak, we investigated the CRE outbreak isolates by using WGS. Twenty-two clinical isolates of CRE, including E. cloacae (n = 15) and K. pneumoniae (n = 7), were sequenced and analyzed genetically. WGS revealed that this outbreak, which seemed epidemiologically unlinked, was in fact genetically linked over a prolonged period. Multiple mechanisms were found to account for the ongoing outbreak of KPC-3-producing E. cloacae and K. pneumoniae. This outbreak was primarily maintained by a clonal expansion of E. cloacae sequence type 114 (ST114) with distribution of multiple resistance determinants. Plasmid and transposon analyses suggested that the majority of blaKPC-3 was transmitted via an identical Tn4401b element on part of a common plasmid. WGS analysis demonstrated complex transmission dynamics within the burn center at levels of the strain and/or plasmid in association with a transposon, highlighting the versatility of KPC-producing Enterobacteriaceae in their ability to utilize multiple modes to resistance gene propagation.
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