Min-Chi Lu1,2, Ying-Tsong Chen3,4, Hui-Ling Tang2, Yen-Yi Liu5, Bo-Han Chen5, You-Wun Wang5, Yi-Syong Chen5, Ru-Hsiou Teng5, Yu-Ping Hong5, Chien-Shun Chiou5, Ming-Ko Chiang6, Yi-Chyi Lai7,8. 1. Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan. 2. Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan. 3. Institute of Molecular and Genomic Medicine, National Health Research Institutes, Miaoli County, Taiwan. 4. Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan. 5. Central Regional Laboratory, Center for Diagnostics and Vaccine Development, Centers for Disease Control, Taichung, Taiwan. 6. Department of Life Science, National Chung Cheng University, Chia-Yi County, Taiwan. 7. Department of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan. 8. Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.
Abstract
OBJECTIVES: Epidemic spread of OXA-48-producing Klebsiella pneumoniae, mainly mediated by the transmission of a blaOXA-48-carrying plasmid, has threatened global health during the last decade. Since its introduction to Taiwan in 2013, OXA-48 has become the second most common carbapenemase. We described the transmission and evolution of an OXA-producing K. pneumoniae clone in a single hospital. METHODS: Twenty-two OXA-48 K. pneumoniae were isolated between October 2013 and December 2015. Comparative genomic analysis was performed based on the WGS data generated with Illumina and MinION techniques. RESULTS: Seventeen of the 22 OXA-48 K. pneumoniae that belonged to ST11, with the same capsular genotype, KL64, and differed from each other by seven or fewer SNPs, were considered outbreak strains. Eight of the 17 outbreak strains harboured a 65499 bp blaOXA-48-carrying IncL plasmid (called pOXA48). pOXA48 was absent from the remaining nine strains. Instead, a 24.9 kb blaOXA-48-carrying plasmid fragment was integrated into a prophage region of their chromosomes. Transmission routes of the ST11_KL64 K. pneumoniae sublineages, which carried either pOXA48 or chromosomally integrated blaOXA-48, were reconstructed. CONCLUSIONS: Clonal expansion of ST11_KL64 sublineages contributed to the nosocomial outbreak of OXA-48 K. pneumoniae. The chromosome-borne blaOXA-48 lineage emerged during a 2 year period in a single hospital. Dissemination of OXA-48, which is vertically transmitted in K. pneumoniae even in the absence of selective pressure from antimicrobials, deserves public health attention.
OBJECTIVES: Epidemic spread of OXA-48-producing Klebsiella pneumoniae, mainly mediated by the transmission of a blaOXA-48-carrying plasmid, has threatened global health during the last decade. Since its introduction to Taiwan in 2013, OXA-48 has become the second most common carbapenemase. We described the transmission and evolution of an OXA-producing K. pneumoniae clone in a single hospital. METHODS: Twenty-two OXA-48K. pneumoniae were isolated between October 2013 and December 2015. Comparative genomic analysis was performed based on the WGS data generated with Illumina and MinION techniques. RESULTS: Seventeen of the 22 OXA-48K. pneumoniae that belonged to ST11, with the same capsular genotype, KL64, and differed from each other by seven or fewer SNPs, were considered outbreak strains. Eight of the 17 outbreak strains harboured a 65499 bp blaOXA-48-carrying IncL plasmid (called pOXA48). pOXA48 was absent from the remaining nine strains. Instead, a 24.9 kb blaOXA-48-carrying plasmid fragment was integrated into a prophage region of their chromosomes. Transmission routes of the ST11_KL64 K. pneumoniae sublineages, which carried either pOXA48 or chromosomally integrated blaOXA-48, were reconstructed. CONCLUSIONS: Clonal expansion of ST11_KL64 sublineages contributed to the nosocomial outbreak of OXA-48K. pneumoniae. The chromosome-borne blaOXA-48 lineage emerged during a 2 year period in a single hospital. Dissemination of OXA-48, which is vertically transmitted in K. pneumoniae even in the absence of selective pressure from antimicrobials, deserves public health attention.
Authors: Ricardo León-Sampedro; Javier DelaFuente; Cristina Díaz-Agero; Thomas Crellen; Patrick Musicha; Jerónimo Rodríguez-Beltrán; Carmen de la Vega; Marta Hernández-García; Nieves López-Fresneña; Patricia Ruiz-Garbajosa; Rafael Cantón; Ben S Cooper; Álvaro San Millán Journal: Nat Microbiol Date: 2021-03-29 Impact factor: 17.745