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A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumoniae involving Intergenus plasmid diffusion and a persisting environmental reservoir.
PLoS One. 2013; 8(3):e59015.Plos

Abstract

BACKGROUND

To study the molecular characteristics of a long-term, low frequency outbreak of bla KPC-2 in a low prevalence setting involving the hospital environment.

METHODOLOGY/PRINCIPAL FINDINGS

KPC-producing bacteria were screened by selective chromogenic agar and Real-Time PCR. The presence of antibiotic resistance genes was ascribed by PCRs and subsequent sequencing, and the KPC-producing isolates were phylogenetically typed using PFGE and multi-locus sequence typing. Bla KPC-2-plasmids were identified and analysed by S1-nuclease-PFGE hybridization and PCR based replicon typing. A ∼97 kb IncFII plasmid was seen to carry bla KPC-2 in all of the clinical isolates, in one of the isolates recovered from screened patients (1/136), and in the Klebsiella pneumoniae and Enterobacter asburiae isolates recovered from the environment (sinks) in one intensive care unit. The K. pneumoniae strain ST258 was identified in 6 out of 7 patients. An intergenus spread to E. asburiae and an interspecies spread to two different K. pneumoniae clones (ST27 and ST461) of the bla KPC-2 plasmid was discovered. K. pneumoniae ST258 and genetically related E. asburiae strains were found in isolates of both human and environmental origins.

CONCLUSIONS/SIGNIFICANCE

We document a clonal transmission of the K. pneumoniae ST258 strain, and an intergenus plasmid diffusion of the IncFII plasmid carrying bla KPC-2 in this outbreak. A major reservoir in the patient population could not be unveiled. However, the identification of a persisting environmental reservoir of strains with molecular determinants linked to human isolates, suggests a possible role of the environment in the maintenance of this long-term outbreak.

Authors+Show Affiliations

Department of Clinical Microbiology, Sørlandet Hospital HF, Kristiansand, Norway. staale.tofteland@sshf.noNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

23536849

Citation

Tofteland, Ståle, et al. "A Long-term Low-frequency Hospital Outbreak of KPC-producing Klebsiella Pneumoniae Involving Intergenus Plasmid Diffusion and a Persisting Environmental Reservoir." PloS One, vol. 8, no. 3, 2013, pp. e59015.
Tofteland S, Naseer U, Lislevand JH, et al. A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumoniae involving Intergenus plasmid diffusion and a persisting environmental reservoir. PLoS One. 2013;8(3):e59015.
Tofteland, S., Naseer, U., Lislevand, J. H., Sundsfjord, A., & Samuelsen, O. (2013). A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumoniae involving Intergenus plasmid diffusion and a persisting environmental reservoir. PloS One, 8(3), e59015. https://doi.org/10.1371/journal.pone.0059015
Tofteland S, et al. A Long-term Low-frequency Hospital Outbreak of KPC-producing Klebsiella Pneumoniae Involving Intergenus Plasmid Diffusion and a Persisting Environmental Reservoir. PLoS One. 2013;8(3):e59015. PubMed PMID: 23536849.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumoniae involving Intergenus plasmid diffusion and a persisting environmental reservoir. AU - Tofteland,Ståle, AU - Naseer,Umaer, AU - Lislevand,Jan Helge, AU - Sundsfjord,Arnfinn, AU - Samuelsen,Orjan, Y1 - 2013/03/11/ PY - 2012/11/26/received PY - 2013/02/08/accepted PY - 2013/3/29/entrez PY - 2013/3/29/pubmed PY - 2013/12/29/medline SP - e59015 EP - e59015 JF - PloS one JO - PLoS One VL - 8 IS - 3 N2 - BACKGROUND: To study the molecular characteristics of a long-term, low frequency outbreak of bla KPC-2 in a low prevalence setting involving the hospital environment. METHODOLOGY/PRINCIPAL FINDINGS: KPC-producing bacteria were screened by selective chromogenic agar and Real-Time PCR. The presence of antibiotic resistance genes was ascribed by PCRs and subsequent sequencing, and the KPC-producing isolates were phylogenetically typed using PFGE and multi-locus sequence typing. Bla KPC-2-plasmids were identified and analysed by S1-nuclease-PFGE hybridization and PCR based replicon typing. A ∼97 kb IncFII plasmid was seen to carry bla KPC-2 in all of the clinical isolates, in one of the isolates recovered from screened patients (1/136), and in the Klebsiella pneumoniae and Enterobacter asburiae isolates recovered from the environment (sinks) in one intensive care unit. The K. pneumoniae strain ST258 was identified in 6 out of 7 patients. An intergenus spread to E. asburiae and an interspecies spread to two different K. pneumoniae clones (ST27 and ST461) of the bla KPC-2 plasmid was discovered. K. pneumoniae ST258 and genetically related E. asburiae strains were found in isolates of both human and environmental origins. CONCLUSIONS/SIGNIFICANCE: We document a clonal transmission of the K. pneumoniae ST258 strain, and an intergenus plasmid diffusion of the IncFII plasmid carrying bla KPC-2 in this outbreak. A major reservoir in the patient population could not be unveiled. However, the identification of a persisting environmental reservoir of strains with molecular determinants linked to human isolates, suggests a possible role of the environment in the maintenance of this long-term outbreak. SN - 1932-6203 UR - https://www.unboundmedicine.com/medline/citation/23536849/A_long_term_low_frequency_hospital_outbreak_of_KPC_producing_Klebsiella_pneumoniae_involving_Intergenus_plasmid_diffusion_and_a_persisting_environmental_reservoir_ L2 - https://dx.plos.org/10.1371/journal.pone.0059015 DB - PRIME DP - Unbound Medicine ER -