TY - JOUR
T1 - A high-resolution genomic analysis of multidrug-resistant hospital outbreaks of Klebsiella pneumoniae
AU - Hao Chung The, null
AU - Karkey, Abhilasha
AU - Thanh, Duy Pham
AU - Boinett, Christine J.
AU - Cain, Amy K.
AU - Ellington, Matthew
AU - Baker, Kate S.
AU - Dongol, Sabina
AU - Thompson, Corinne
AU - Harris, Simon R.
AU - Jombart, Thibaut
AU - Tu Le Thi Phuong, null
AU - Nhu Tran Do Hoang, null
AU - Tuyen Ha Thanh, null
AU - Shretha, Shrijana
AU - Joshi, Suchita
AU - Basnyat, Buddha
AU - Thwaites, Guy
AU - Thomson, Nicholas R.
AU - Rabaa, Maia A.
AU - Baker, Stephen
N1 - Copyright the Author(s) 2015. Version archived for private and non-commercial use with the permission of the author/s and according to publisher conditions. For further rights please contact the publisher.
PY - 2015/3/1
Y1 - 2015/3/1
N2 - Multidrug-resistant (MDR) Klebsiella pneumoniae has become a leading cause of nosocomial infections worldwide. Despite itsprominence, little is known about the genetic diversity of K.pneumoniae in resource-poor hospital settings. Through whole-genome sequencing (WGS), we reconstructed an outbreak of MDR K.pneumoniae occurring on high-dependency wards in a hospital in Kathmandu during 2012 with a case-fatality rate of 75%. The WGS analysis permitted the identification of two MDR K.pneumoniae lineages causing distinct outbreaks within the complex endemic K.pneumoniae. Using phylogenetic reconstruction and lineage-specific PCR, our data predicted a scenario in which K.pneumoniae, circulating for 6months before the outbreak, underwent a series of ward-specific clonal expansions after the acquisition of genes facilitating virulence and MDR. We suggest that the early detection of a specific NDM-1 containing lineage in 2011 would have alerted the high-dependency ward staff to intervene. We argue that some form of real-time genetic characterisation, alongside clade-specific PCR during an outbreak, should be factored into future healthcare infection control practices in both high- and low-income settings.
AB - Multidrug-resistant (MDR) Klebsiella pneumoniae has become a leading cause of nosocomial infections worldwide. Despite itsprominence, little is known about the genetic diversity of K.pneumoniae in resource-poor hospital settings. Through whole-genome sequencing (WGS), we reconstructed an outbreak of MDR K.pneumoniae occurring on high-dependency wards in a hospital in Kathmandu during 2012 with a case-fatality rate of 75%. The WGS analysis permitted the identification of two MDR K.pneumoniae lineages causing distinct outbreaks within the complex endemic K.pneumoniae. Using phylogenetic reconstruction and lineage-specific PCR, our data predicted a scenario in which K.pneumoniae, circulating for 6months before the outbreak, underwent a series of ward-specific clonal expansions after the acquisition of genes facilitating virulence and MDR. We suggest that the early detection of a specific NDM-1 containing lineage in 2011 would have alerted the high-dependency ward staff to intervene. We argue that some form of real-time genetic characterisation, alongside clade-specific PCR during an outbreak, should be factored into future healthcare infection control practices in both high- and low-income settings.
KW - antimicrobial resistance
KW - bloodstream infections
KW - carbapenemases
KW - Klebsiella pneumoniae
KW - nosocomial infections
UR - http://www.scopus.com/inward/record.url?scp=84929838068&partnerID=8YFLogxK
U2 - 10.15252/emmm.201404767
DO - 10.15252/emmm.201404767
M3 - Article
C2 - 25712531
SN - 1757-4676
VL - 7
SP - 227
EP - 239
JO - EMBO Molecular Medicine
JF - EMBO Molecular Medicine
IS - 3
ER -