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An Outbreak of KPC-Producing Klebsiella pneumoniae Linked with an Index Case of Community-Acquired KPC-Producing Isolate: Epidemiological Investigation and Whole Genome Sequencing Analysis

Authors
 Je Eun Song  ;  Haeyoung Jeong  ;  Young Sun Lim  ;  Eun Jin Ha  ;  In Young Jung  ;  Wooyong Jeong  ;  Heun Choi  ;  Su Jin Jeong  ;  Nam Su Ku  ;  Eun Suk Park  ;  Dongeun Yong  ;  Kyungwon Lee  ;  June Myung Kim  ;  Jun Yong Choi 
Citation
 MICROBIAL DRUG RESISTANCE, Vol.25(10) : 1475-1483, 2019-12 
Journal Title
MICROBIAL DRUG RESISTANCE
ISSN
 1076-6294 
Issue Date
2019-12
MeSH
Aged ; Aged, 80 and over ; Anti-Bacterial Agents / pharmacology ; Bacterial Proteins / genetics ; Community-Acquired Infections / epidemiology* ; Community-Acquired Infections / microbiology ; Disease Outbreaks* ; Drug Resistance, Bacterial / genetics ; Humans ; Klebsiella Infections / epidemiology* ; Klebsiella Infections / microbiology ; Klebsiella pneumoniae / genetics ; Klebsiella pneumoniae / isolation & purification* ; Male ; Plasmids / genetics ; Republic of Korea / epidemiology ; Sputum / microbiology ; Tertiary Care Centers ; Whole Genome Sequencing ; beta-Lactamases / genetics
Keywords
Klebsiella pneumoniae carbapenemase ; outbreak ; whole genome sequencing analysis
Abstract
Aims: A hospital outbreak of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPN) linked with an index case of community-acquired infection occurred in an urban tertiary care hospital in Seoul, South Korea. Therefore, we performed an outbreak investigation and whole genome sequencing (WGS) analysis to trace the outbreak and investigate the molecular characteristics of the isolates. Results: From October 2014 to January 2015, we identified a cluster of three patients in the neurosurgery ward with sputum cultures positive for carbapenem-resistant KPN. An epidemiological investigation, including pulsed-field gel electrophoresis analysis was performed to trace the origins of this outbreak. The index patient's infection was community acquired. Active surveillance cultures using perirectal swabbing from exposed patients, identified one additional patient with KPC-producing KPN colonization. WGS analyses using PacBio RSII instruments were performed for four linked isolates. WGS revealed a genetic linkage of the four isolates belonging to the same sequence type (ST307). All KPN isolates harbored conjugative resistance plasmids, which has bla(KPC-2) carbapenemase genes contained within the Tn4401 "a" isoform and other resistance genes. However, WGS showed only three isolates among four KPC-producing KPN were originated from a common origin. Conclusions: This report demonstrates the challenge that KPC-2-producing KPN with the conjugative resistance plasmid may spread not only in hospitals but also in community, and WGS can help to accurately characterize the outbreak.
Full Text
https://www.liebertpub.com/doi/10.1089/mdr.2018.0475
DOI
10.1089/mdr.2018.0475
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Laboratory Medicine (진단검사의학교실) > 1. Journal Papers
Yonsei Authors
Ku, Nam Su(구남수) ORCID logo https://orcid.org/0000-0002-9717-4327
Kim, June Myung(김준명)
Song, Je Eun(송제은)
Yong, Dong Eun(용동은) ORCID logo https://orcid.org/0000-0002-1225-8477
Lee, Kyungwon(이경원) ORCID logo https://orcid.org/0000-0003-3788-2134
Jeong, Su Jin(정수진) ORCID logo https://orcid.org/0000-0003-4025-4542
Jeong, Wooyong(정우용)
Jung, In Young(정인영)
Choi, Jun Yong(최준용) ORCID logo https://orcid.org/0000-0002-2775-3315
Choi, Heun(최흔) ORCID logo https://orcid.org/0000-0002-9622-9381
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/189198
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