A high-resolution genomic analysis of multidrug-resistant hospital outbreaks of Klebsiella pneumoniae.

Chung The, H; Karkey, A; Pham Thanh, D; Boinett, CJ; Cain, AK; Ellington, M; Baker, KS; Dongol, S; Thompson, C; Harris, SR; Jombart, T; Le Thi Phuong, T; Tran Do Hoang, N; Ha Thanh, T; Shretha, S; Joshi, S; Basnyat, B; Thwaites, G; Thomson, NR; Rabaa, MA; Baker, S; (2015) A high-resolution genomic analysis of multidrug-resistant hospital outbreaks of Klebsiella pneumoniae. EMBO molecular medicine, 7 (3). pp. 227-39. ISSN 1757-4676 DOI: https://doi.org/10.15252/emmm.201404767

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: Multidrug-resistant (MDR) Klebsiella pneumoniae has become a leading cause of nosocomial infections worldwide. Despite its prominence, 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 6 months 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.<br/>

Item Type: Article
Faculty and Department: Faculty of Infectious and Tropical Diseases > Dept of Pathogen Molecular Biology
Research Centre: Antimicrobial Resistance Centre (AMR)
PubMed ID: 25712531
URI: http://researchonline.lshtm.ac.uk/id/eprint/2137819


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