Tracking Carbapenem-Producing Klebsiella pneumoniae Outbreak in an Intensive Care Unit by Whole Genome Sequencing
Tracking Carbapenem-Producing Klebsiella pneumoniae Outbreak in an Intensive Care Unit by Whole Genome Sequencing
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DOI：
10.3389/fcimb.2019.00281
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发表时间：
2019-08-08
影响因子：
5.7
通讯作者：
Zhang, Wen-Hong
中科院分区：
文献类型：
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作者：
Chen, Chen;Zhang, Yi;Zhang, Wen-Hong
产碳青霉烯类肺炎克雷伯菌(CP-KP)的存在严重威胁着医院感染的控制。质粒介导的耐药基因水平转移使控制医院获得性CP-KP感染变得困难。在中国东部的上海华山医院重症监护室暴发疫情中分离到9株CP-KP菌株。我们进行了一项回顾性研究，以确定此次CP-KP疫情的来源和传播途径。对8例患者的9株临床分离株进行全基因组测序，并与临床和流行病学资料进行比较。所有分离株均为ST11 CP-KP菌株。单核苷酸多态和质粒的存在和结构表明，这次CP-KP暴发有不同的来源。根据遗传距离将这9个菌株划分为两个分支。在9个分离物中检测到CP002474.1、CP006799.1、CP018455.1和CP025459.1四种质粒。与测序结果一致的是质粒系统发育和抗药性基因图谱结果。我们发现，CP-KP的两个分支导致了这次院内暴发，并展示了两个指标患者的传播途径。质粒携带和系统发育是鉴定参与疾病传播的分支的有用工具。
The presence of carbapenem-producing Klebsiella pneumoniae (CP-Kp) is a serious threat to the control of nosocomial infections. Plasmid-mediated horizontal transfer of the resistance gene makes it difficult to control hospital-acquired CP-Kp infections. Nine CP-Kp strains were isolated during an outbreak in the intensive care unit of Shanghai Huashan hospital in east China. We conducted a retrospective study to identify the origin and route of transmission of this CP-Kp outbreak. Whole-genome sequencing (WGS) analysis was performed on 9 clinical isolates obtained from 8 patients, and the results were compared to clinical and epidemiological records. All isolates were ST11 CP-Kp. Single-nucleotide polymorphisms and the presence and structure of plasmids indicated that this CP-Kp outbreak had different origins. These 9 isolates were partitioned into two clades according to genetic distance. Four plasmids, CP002474.1, CP006799.1, CP018455.1, and CP025459.1, were detected among the 9 isolates. The plasmid phylogeny and antibiotic resistance (AR) gene profile results were consistent with the sequencing results. We found that two clades of CP-Kp were responsible for this nosocomial outbreak and demonstrated the transmission route from two index patients. Plasmid carriage and phylogeny are a useful tool for identifying clades involved in disease transmission.