Investigation of outbreaks of extended-spectrum beta-lactamase-producing klebsiella pneumoniae in three neonatal intensive care units using whole genome sequencing

Sammy Frenk, Nadya Rakovitsky, Elizabeth Temkin, Vered Schechner, Regev Cohen, Bat Sheva Kloyzner, Mitchell J. Schwaber, Ester Solter, Shoshana Cohen, Sarit Stepansky, Yehuda Carmeli

Research output: Contribution to journalArticlepeer-review

Abstract

Infections caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) are on a constant rise and are a noted cause of outbreaks in neonatal intensive care units (NICUs). We used whole genome sequencing (WGS) to investigate the epidemiology of consecutive and overlapping outbreaks caused by ESBL-KP in NICUs in three hospitals in close proximity. Clonality of 43 ESBL-KP isolates from 40 patients was determined by BOX-PCR. Short-read sequencing was performed on representative isolates from each clone. The dominant clones from each NICU were sequenced using long-read sequencing. Bioinformatics methods were used to define multilocus sequence type (MLST), analyze plasmid content, resistomes, and virulence factors. In each NICU, we found a unique dominant clone (ST985, ST37, and ST35), each belonging to a distinct sequence type (ST), as well as satellite clones. A satellite strain in NICU-2 (ST35) was the dominant strain in NICU-3, where it was isolated four weeks later, suggesting transmission. NICU-1-and NICU-2-dominant strains had blaCTX-M-15 carried on a similar transposable element (Tn3-ISEcp1) but at different locations: on a plasmid and on the chromosome, respectively. We concluded that the overlapping ESBL-KP outbreaks were a combination of clonal transmission within NICUs, possible transposable element transmission between NICUs, and repeated importation of ESBL-KP from the community.

Original languageEnglish
Article number705
Pages (from-to)1-10
Number of pages10
JournalAntibiotics
Volume9
Issue number10
DOIs
StatePublished - Oct 2020

Keywords

  • Dual technology WGS
  • ESBL-KP
  • Neonatal ICU
  • Outbreak

Fingerprint

Dive into the research topics of 'Investigation of outbreaks of extended-spectrum beta-lactamase-producing klebsiella pneumoniae in three neonatal intensive care units using whole genome sequencing'. Together they form a unique fingerprint.

Cite this