@article{3187467,
    title = "Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is
driven by nosocomial spread",
    author = "David, Sophia and Reuter, Sandra and Harris, Simon R. and Glasner, and Corinna and Feltwell, Theresa and Argimon, Silvia and Abudahab, Khalil and and Goater, Richard and Giani, Tommaso and Errico, Giulia and Aspbury, and Marianne and Sjunnebo, Sara and Feil, Edward J. and Rossolini, Gian and Maria and Aanensen, David M. and Grundmann, Hajo and Koraqi, Andi and and Lacej, Denada and Apfalter, Petra and Hartl, Rainer and Glupczynski, and Youri and Huang, Te-Din and Strateva, Tanya and Marteva-Proevska, Yuliya and and Tambic Andrasevic, Arjana and Butic, Iva and Pieridou-Bagatzouni, and Despo and Maikanti-Charalampous, Panagiota and Hrabak, Jaroslav and and Zemlickova, Helena and Hammerum, Anette and Jakobsen, Lotte and Ivanova, and Marina and Pavelkovich, Anastasia and Jalava, Jari and Osterblad, Monica and and Dortet, Laurent and Vaux, Sophie and Kaase, Martin and Gatermann, and Soeren G. and Vatopoulos, Alkiviadis and Tryfinopoulou, Kyriaki and and Toth, Akos and Janvari, Laura and Boo, Teck Wee and McGrath, Elaine and and Carmeli, Yehuda and Adler, Amos and Pantosti, Annalisa and Monaco, and Monica and Raka, Lul and Kurti, Arsim and Balode, Arta and Saule, Mara and and Miciuleviciene, Jolanta and Mierauskaite, Aiste and Perrin-Weniger, and Monique and Reichert, Paul and Nestorova, Nina and Debattista, Sonia and and Mijovic, Gordana and Lopicic, Milena and Samuelsen, Orjan and Haldorsen, and Bjorg and Zabicka, Dorota and Literacka, Elzbieta and Canica, Manuela and and Manageiro, Vera and Kaftandzieva, Ana and Trajkovska-Dokic, Elena and and Damian, Maria and Lixandru, Brandusa and Jelesic, Zora and Trudic, and Anika and Niks, Milan and Schreterova, Eva and Pirs, Mateja and Cerar, and Tjasa and Oteo, Jesus and Aracil, Belen and Giske, Christian and and Sjostrom, Karin and Gur, Deniz and Cakar, Asli and Woodford, Neil and and Hopkins, Katie and Wiuff, Camilla and Brown, Derek J. and EuSCAPE and Working Grp and ESGEM Study Grp",
    journal = "Nature Microbiology",
    year = "2019",
    volume = "4",
    number = "11",
    pages = "1919-1929",
    publisher = "Lithuanian Nature Research Centre",
    issn = "2058-5276",
    doi = "10.1038/s41564-019-0492-8",
    abstract = "Public health interventions to control the current epidemic of
carbapenem-resistant Klebsiella pneumoniae rely on a comprehensive
understanding of its emergence and spread over a wide range of
geographical scales. We analysed the genome sequences and
epidemiological data of >1,700 K. pneumoniae samples isolated from
patients in 244 hospitals in 32 countries during the European Survey of
Carbapenemase-Producing Enterobacteriaceae. We demonstrate that
carbapenemase acquisition is the main cause of carbapenem resistance and
that it occurred across diverse phylogenetic backgrounds. However, 477
of 682 (69.9%) carbapenemase-positive isolates are concentrated in four
clonal lineages, sequence types 11,15,101, 258/512 and their
derivatives. Combined analysis of the genetic and geographic distances
between isolates with different beta-lactam resistance determinants
suggests that the propensity of K. pneumoniae to spread in hospital
environments correlates with the degree of resistance and that
carbapenemase-positive isolates have the highest transmissibility.
Indeed, we found that over half of the hospitals that contributed
carbapenemase-positive isolates probably experienced within-hospital
transmission, and interhospital spread is far more frequent within,
rather than between, countries. Finally, we propose a value of 21 for
the number of single nucleotide polymorphisms that optimizes the
discrimination of hospital clusters and detail the international spread
of the successful epidemic lineage, ST258/512."
}