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High clonal diversity of ESBL-producing Klebsiella pneumoniae isolates from clinical samples in a non-outbreak situation. A cohort study

Authors
  • Xercavins, Mariona1, 2
  • Jiménez, Elena1
  • Padilla, Emma1
  • Riera, Montserrat3
  • Freixas, Núria3
  • Boix-Palop, Lucia2, 3
  • Pérez, Josefa1
  • Calbo, Esther2, 3
  • 1 CATLAB, Terrassa, Barcelona, Spain , Terrassa (Spain)
  • 2 Universitat Internacional de Catalunya, C/ Josep Trueta s/n, Sant Cugat del Vallès, Barcelona, 08195, Spain , Sant Cugat del Vallès (Spain)
  • 3 Hospital Universitari Mutua de Terrassa, Plaza Dr Robert 5, Terrassa, Barcelona, 08221, Spain , Terrassa (Spain)
Type
Published Article
Journal
Antimicrobial Resistance & Infection Control
Publisher
BioMed Central
Publication Date
Jan 03, 2020
Volume
9
Issue
1
Identifiers
DOI: 10.1186/s13756-019-0661-9
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundKlebsiella pneumoniae has been responsible for a large number of clonal hospital outbreaks. However, some epidemiological changes have been observed since the emergence of CTX-M enzymes in K. pneumoniae.AimTo analyse the transmission dynamics of Extended Spectrum β-Lactamase-producing Klebsiella pneumoniae (ESBL-Kp) in an acute care hospital.MethodsIn 2015 a prospective cohort study was conducted. All new consecutive adult patients with ESBL-Kp isolates in all clinical samples were included. Patients with a previous known infection/colonization by ESBL-Kp and patients in high risk areas (e.g., intensive care units) were excluded. Cross-transmission was defined as the carriage of a clonally-related ESBL-Kp between newly diagnosed patients who shared the same ward for ≥48 h with another case, within a maximum time window of 4 weeks. ESBL-production was confirmed using the double-disk diffusion method and PCR. Clonal relationships were investigated by rep-PCR and multilocus sequence typing (MLST).ResultsSixty ESBL-Kp isolates from 60 patients were included and analysed. Infections and colonizations were classified as hospital-acquired (52%), healthcare-related (40%) or community-acquired (8%).High genetic diversity was detected. When epidemiological clinical data were combined with the rep-PCR, the patterns identified did not show any cases of cross-transmission. ESBL-Kp were detected in 12.5% of environmental samples. No clonal relationship could be established between environmental reservoirs and patients. The genetic mechanism detected in all strains was associated with blaCTX-M genes, and 97% were CTX-M-15.ConclusionsThe dynamics of ESBL-K. pneumoniae isolated in our setting could not be explained by clonal transmission from an index patient. A polyclonal spread of ESBL-Kp was identified.

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