Investigation of Outbreaks of Extended-Spectrum Beta-Lactamase-Producing Klebsiella Pneumoniae in Three Neonatal Intensive Care Units Using Whole Genome Sequencing.
Investigation of Outbreaks of Extended-Spectrum Beta-Lactamase-Producing Klebsiella Pneumoniae in Three Neonatal Intensive Care Units Using Whole Genome Sequencing.
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DOI：
10.3390/antibiotics9100705
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发表时间：
2020-10-16
期刊：
影响因子：
--
通讯作者：
Carmeli Y
中科院分区：
文献类型：
--
作者：
Frenk S;Rakovitsky N;Temkin E;Schechner V;Cohen R;Kloyzner BS;Schwaber MJ;Solter E;Cohen S;Stepansky S;Carmeli Y
产超广谱β-内酰胺酶肺炎克雷伯菌（ESBL-KP）引起的感染不断增加，是新生儿重症监护病房（NICU）爆发的一个重要原因。我们使用全基因组测序（WGS）来调查三家医院附近NICU中ESBL-KP引起的连续和重叠暴发的流行病学。用BOX-PCR方法检测40例患者43株ESBL-KP的克隆性。对来自每个克隆的代表性分离株进行短读测序。使用长读段测序对来自每个NICU的优势克隆进行测序。利用生物信息学方法确定多位点序列类型（MLST），分析质粒含量、耐药基因和毒力因子。在每个新生儿重症监护室，我们发现了一个独特的显性克隆（ST 985，ST 37和ST 35），每个属于一个不同的序列类型（ST），以及卫星克隆。NICU-2中的卫星菌株（ST 35）是NICU-3中的优势菌株，四周后分离出，表明传播。NICU-1-和NICU-2-优势菌株具有blaCTX-M-15，其携带在相似的转座因子（Tn 3-ISEcp 1）上，但位于不同的位置：分别在质粒和染色体上。我们的结论是，重叠ESBL-KP爆发是NICU内的克隆传播，NICU之间可能的转座因子传播和社区ESBL-KP重复输入的组合。
Infections caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) are on a constant rise and are a noted cause of outbreaks in neonatal intensive care units (NICUs). We used whole genome sequencing (WGS) to investigate the epidemiology of consecutive and overlapping outbreaks caused by ESBL-KP in NICUs in three hospitals in close proximity. Clonality of 43 ESBL-KP isolates from 40 patients was determined by BOX-PCR. Short-read sequencing was performed on representative isolates from each clone. The dominant clones from each NICU were sequenced using long-read sequencing. Bioinformatics methods were used to define multilocus sequence type (MLST), analyze plasmid content, resistomes, and virulence factors. In each NICU, we found a unique dominant clone (ST985, ST37, and ST35), each belonging to a distinct sequence type (ST), as well as satellite clones. A satellite strain in NICU-2 (ST35) was the dominant strain in NICU-3, where it was isolated four weeks later, suggesting transmission. NICU-1- and NICU-2-dominant strains had blaCTX-M-15 carried on a similar transposable element (Tn3-ISEcp1) but at different locations: on a plasmid and on the chromosome, respectively. We concluded that the overlapping ESBL-KP outbreaks were a combination of clonal transmission within NICUs, possible transposable element transmission between NICUs, and repeated importation of ESBL-KP from the community.
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影响因子：
2.9
作者：
Haller, Sebastian;Eller, Christoph;Nuebel, Ulrich
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