Jiyon Chu, Jaeki Choi, Seul Ki Ji, Chulmin Park, Seung-Hyun Jung, Sun Hee Park, Dong-Gun Lee
{"title":"韩国一家医院爆发产 blaKPC-4 和 blaVIM-1 肺炎克雷伯菌和变异克雷伯菌疫情。","authors":"Jiyon Chu, Jaeki Choi, Seul Ki Ji, Chulmin Park, Seung-Hyun Jung, Sun Hee Park, Dong-Gun Lee","doi":"10.1186/s13756-024-01478-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The dissemination of Klebsiella spp. producing multiple carbapenemases has been increasingly recognized. Between July 2019 and August 2021, ten patients were found to carry Klebsiella spp. co-harboring bla<sub>KPC-4</sub> and bla<sub>VIM-1</sub> across multiple wards at a Korean hospital, and one isolate was recovered from a hand-washing sink, more than a year after the outbreak. This study aimed to investigate the outbreak and conduct a genomic study of these isolates.</p><p><strong>Methods: </strong>Whole-genome sequencing, including long-read sequencing, was performed to analyze plasmid structures and mobile genetic elements (MGEs). Bioinformatics analyses were performed to trace clonal transmission chains and horizontal gene transfer.</p><p><strong>Results: </strong>The findings suggested that the inter-ward spread of Klebsiella spp. seemed to be facilitated by healthcare worker contact or patient movement. Of the nine isolates collected (eight clinical and one environmental), seven (including the environmental isolate) were identified as K. pneumoniae (ST3680) and two were K. variicola (single-locus variant of ST5252). These isolates showed high genetic relatedness within their species and harbored the IncHI5B plasmid carrying both bla<sub>KPC-4</sub> and bla<sub>VIM-1</sub> (pKPCVIM.1). On this plasmid, bla<sub>VIM-1</sub> was located in the Class 1 integron associated with IS1326::IS1353 (In2), and Tn4401b carrying bla<sub>KPC-4</sub> was inserted into IS1326::IS1353, creating a novel MGE construct (In2_bla<sub>VIM-1</sub>-Tn4401b_bla<sub>KPC-4</sub>).</p><p><strong>Conclusion: </strong>The hospital-wide spread of bla<sub>KPC-4</sub> and bla<sub>VIM-1</sub> was facilitated by clonal spread and horizontal plasmid transfer. The persistence of this strain in the hospital sink suggests a potential reservoir of the strain. Understanding the transmission mechanisms of persistent pathogens is important for improving infection control strategies in hospitals.</p>","PeriodicalId":7950,"journal":{"name":"Antimicrobial Resistance and Infection Control","volume":"13 1","pages":"123"},"PeriodicalIF":4.8000,"publicationDate":"2024-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470574/pdf/","citationCount":"0","resultStr":"{\"title\":\"An outbreak of bla<sub>KPC-4</sub>- and bla<sub>VIM-1</sub>-producing Klebsiella pneumoniae and Klebsiella variicola at a single hospital in South Korea.\",\"authors\":\"Jiyon Chu, Jaeki Choi, Seul Ki Ji, Chulmin Park, Seung-Hyun Jung, Sun Hee Park, Dong-Gun Lee\",\"doi\":\"10.1186/s13756-024-01478-2\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The dissemination of Klebsiella spp. producing multiple carbapenemases has been increasingly recognized. Between July 2019 and August 2021, ten patients were found to carry Klebsiella spp. co-harboring bla<sub>KPC-4</sub> and bla<sub>VIM-1</sub> across multiple wards at a Korean hospital, and one isolate was recovered from a hand-washing sink, more than a year after the outbreak. This study aimed to investigate the outbreak and conduct a genomic study of these isolates.</p><p><strong>Methods: </strong>Whole-genome sequencing, including long-read sequencing, was performed to analyze plasmid structures and mobile genetic elements (MGEs). Bioinformatics analyses were performed to trace clonal transmission chains and horizontal gene transfer.</p><p><strong>Results: </strong>The findings suggested that the inter-ward spread of Klebsiella spp. seemed to be facilitated by healthcare worker contact or patient movement. Of the nine isolates collected (eight clinical and one environmental), seven (including the environmental isolate) were identified as K. pneumoniae (ST3680) and two were K. variicola (single-locus variant of ST5252). These isolates showed high genetic relatedness within their species and harbored the IncHI5B plasmid carrying both bla<sub>KPC-4</sub> and bla<sub>VIM-1</sub> (pKPCVIM.1). On this plasmid, bla<sub>VIM-1</sub> was located in the Class 1 integron associated with IS1326::IS1353 (In2), and Tn4401b carrying bla<sub>KPC-4</sub> was inserted into IS1326::IS1353, creating a novel MGE construct (In2_bla<sub>VIM-1</sub>-Tn4401b_bla<sub>KPC-4</sub>).</p><p><strong>Conclusion: </strong>The hospital-wide spread of bla<sub>KPC-4</sub> and bla<sub>VIM-1</sub> was facilitated by clonal spread and horizontal plasmid transfer. The persistence of this strain in the hospital sink suggests a potential reservoir of the strain. Understanding the transmission mechanisms of persistent pathogens is important for improving infection control strategies in hospitals.</p>\",\"PeriodicalId\":7950,\"journal\":{\"name\":\"Antimicrobial Resistance and Infection Control\",\"volume\":\"13 1\",\"pages\":\"123\"},\"PeriodicalIF\":4.8000,\"publicationDate\":\"2024-10-11\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11470574/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Antimicrobial Resistance and Infection Control\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1186/s13756-024-01478-2\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Antimicrobial Resistance and Infection Control","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1186/s13756-024-01478-2","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
An outbreak of blaKPC-4- and blaVIM-1-producing Klebsiella pneumoniae and Klebsiella variicola at a single hospital in South Korea.
Background: The dissemination of Klebsiella spp. producing multiple carbapenemases has been increasingly recognized. Between July 2019 and August 2021, ten patients were found to carry Klebsiella spp. co-harboring blaKPC-4 and blaVIM-1 across multiple wards at a Korean hospital, and one isolate was recovered from a hand-washing sink, more than a year after the outbreak. This study aimed to investigate the outbreak and conduct a genomic study of these isolates.
Methods: Whole-genome sequencing, including long-read sequencing, was performed to analyze plasmid structures and mobile genetic elements (MGEs). Bioinformatics analyses were performed to trace clonal transmission chains and horizontal gene transfer.
Results: The findings suggested that the inter-ward spread of Klebsiella spp. seemed to be facilitated by healthcare worker contact or patient movement. Of the nine isolates collected (eight clinical and one environmental), seven (including the environmental isolate) were identified as K. pneumoniae (ST3680) and two were K. variicola (single-locus variant of ST5252). These isolates showed high genetic relatedness within their species and harbored the IncHI5B plasmid carrying both blaKPC-4 and blaVIM-1 (pKPCVIM.1). On this plasmid, blaVIM-1 was located in the Class 1 integron associated with IS1326::IS1353 (In2), and Tn4401b carrying blaKPC-4 was inserted into IS1326::IS1353, creating a novel MGE construct (In2_blaVIM-1-Tn4401b_blaKPC-4).
Conclusion: The hospital-wide spread of blaKPC-4 and blaVIM-1 was facilitated by clonal spread and horizontal plasmid transfer. The persistence of this strain in the hospital sink suggests a potential reservoir of the strain. Understanding the transmission mechanisms of persistent pathogens is important for improving infection control strategies in hospitals.
期刊介绍：
Antimicrobial Resistance and Infection Control is a global forum for all those working on the prevention, diagnostic and treatment of health-care associated infections and antimicrobial resistance development in all health-care settings. The journal covers a broad spectrum of preeminent practices and best available data to the top interventional and translational research, and innovative developments in the field of infection control.
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