Use of whole-genome sequencing to trace, control and characterize the regional expansion of extended-spectrum β-lactamase producing ST15 Klebsiella pneumoniae

Sci Rep. 2016 Feb 11:6:20840. doi: 10.1038/srep20840.

Abstract

The study describes the transmission of a CTX-M-15-producing ST15 Klebsiella pneumoniae between patients treated in a single center and the subsequent inter-institutional spread by patient referral occurring between May 2012 and September 2013. A suspected epidemiological link between clinical K. pneumoniae isolates was supported by patient contact tracing and genomic phylogenetic analysis from May to November 2012. By May 2013, a patient treated in three institutions in two cities was involved in an expanding cluster caused by this high-risk clone (HiRiC) (local expansion, CTX-M-15 producing, and containing hypervirulence factors). A clone-specific multiplex PCR was developed for patient screening by which another patient was identified in September 2013. Genomic phylogenetic analysis including published ST15 genomes revealed a close homology with isolates previously found in the USA. Environmental contamination and lack of consistent patient screening were identified as being responsible for the clone dissemination. The investigation addresses the advantages of whole-genome sequencing in the early detection of HiRiC with a high propensity of nosocomial transmission and prolonged circulation in the regional patient population. Our study suggests the necessity for inter-institutional/regional collaboration for infection/outbreak management of K. pneumoniae HiRiCs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Typing Techniques
  • Clone Cells
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology*
  • Cross Infection / pathology
  • Cross Infection / transmission
  • Disease Outbreaks*
  • Gene Expression
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Klebsiella Infections / drug therapy
  • Klebsiella Infections / epidemiology*
  • Klebsiella Infections / pathology
  • Klebsiella Infections / transmission
  • Klebsiella pneumoniae / drug effects
  • Klebsiella pneumoniae / genetics*
  • Klebsiella pneumoniae / isolation & purification
  • Klebsiella pneumoniae / pathogenicity*
  • Multiplex Polymerase Chain Reaction
  • Netherlands / epidemiology
  • Patient Identification Systems
  • Public Health Surveillance
  • Virulence
  • beta-Lactam Resistance / genetics
  • beta-Lactamases / genetics
  • beta-Lactamases / metabolism
  • beta-Lactams / therapeutic use

Substances

  • Anti-Bacterial Agents
  • beta-Lactams
  • beta-lactamase CTX-M-15
  • beta-Lactamases