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首页> 外文期刊>Journal of Clinical Microbiology >Tracking Nosocomial Klebsiella pneumoniae Infections and Outbreaks by Whole-Genome Analysis: Small-Scale Italian Scenario within a Single Hospital
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Tracking Nosocomial Klebsiella pneumoniae Infections and Outbreaks by Whole-Genome Analysis: Small-Scale Italian Scenario within a Single Hospital

机译：通过全基因组分析追踪医院内肺炎克雷伯菌的感染和暴发：单个医院内的小型意大利病例

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Multidrug-resistant (MDR) Klebsiella pneumoniae is one of the most important causes of nosocomial infections worldwide. After the spread of strains resistant to beta-lactams at the end of the previous century, the diffusion of isolates resistant to carbapenems and colistin is now reducing treatment options and the containment of infections. Carbapenem-resistant K. pneumoniae strains have spread rapidly among Italian hospitals, with four subclades of pandemic clonal group 258 (CG258). Here we show that a single Italian hospital has been invaded by three of these subclades within 27 months, thus replicating on a small scale the “Italian scenario.” We identified a single clone responsible for an epidemic outbreak involving seven patients, and we reconstructed its star-like pattern of diffusion within the intensive care unit. This epidemiological picture was obtained through phylogenomic analysis of 16 carbapenem-resistant K. pneumoniae isolates collected in the hospital during a 27-month period, which were added to a database of 319 genomes representing the available global diversity of K. pneumoniae strains. Phenotypic and molecular assays did not reveal virulence or resistance determinants specific for the outbreak isolates. Other factors, rather than selective advantages, might have caused the outbreak. Finally, analyses allowed us to identify a major subclade of CG258 composed of strains bearing the yersiniabactin virulence factor. Our work demonstrates how the use of combined phenotypic, molecular, and whole-genome sequencing techniques can help to identify quickly and to characterize accurately the spread of MDR pathogens.
机译：多重耐药性（MDR）肺炎克雷伯菌是全世界医院感染的最重要原因之一。在上个世纪末对β-内酰胺类产生抗药性的菌株传播后，对碳青霉烯类和大肠粘菌素具有抗性的分离株的扩散现在正在减少治疗选择和感染控制。带有碳青霉烯抗性的肺炎克雷伯菌菌株在意大利医院中迅速传播，有四个大流行无性系258组（CG258）子群。在这里，我们显示，一家意大利医院在27个月内遭到了其中三个分支的入侵，因此在很小的程度上复制了“意大利情节”。我们确定了一个涉及7名患者的流行病暴发的克隆，并在重症监护病房中重建了其星形扩散模式。该流行病学图片是通过对27个月期间在医院收集到的16种对碳青霉烯类耐药的肺炎克雷伯菌菌株进行系统生物学分析而获得的，这些菌株被添加到代表319个基因组的数据库中，这些数据库代表了肺炎克雷伯菌菌株的可用全球多样性。表型和分子测定未显示对于爆发分离株具有特异性的毒力或耐药性决定因素。其他因素（而非选择性优势）可能是造成疫情的原因。最后，分析使我们能够确定CG258的主要亚群，该亚群由带有耶尔森菌素毒力因子的菌株组成。我们的工作证明了结合表型，分子和全基因组测序技术的使用如何能够帮助快速识别并准确表征MDR病原体的传播。

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