A Long-Term Low-Frequency Hospital Outbreak of KPC-Producing Klebsiella pneumoniae Involving Intergenus Plasmid Diffusion and a Persisting Environmental Reservoir
Permanent link
https://hdl.handle.net/10037/6048Date
2013Type
Journal articleTidsskriftartikkel
Peer reviewed
Author
Tofteland, Ståle; Naseer, Mohammed Umaer; Lislevand, Jan Helge; Sundsfjord, Arnfinn; Samuelsen, ØrjanAbstract
Background: To study the molecular characteristics of a long-term, low frequency outbreak of blaKPC-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. BlaKPC-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
blaKPC-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 blaKPC-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 blaKPC-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.
Publisher
Public Library of Science (PLoS)Citation
PLoS ONE (2013), vol. 8(3): e59015.Metadata
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