Περίληψη:
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.
Συγγραφείς:
David, Sophia
Reuter, Sandra
Harris, Simon R.
Glasner,
Corinna
Feltwell, Theresa
Argimon, Silvia
Abudahab, Khalil
and Goater, Richard
Giani, Tommaso
Errico, Giulia
Aspbury,
Marianne
Sjunnebo, Sara
Feil, Edward J.
Rossolini, Gian
Maria
Aanensen, David M.
Grundmann, Hajo
Koraqi, Andi and
Lacej, Denada
Apfalter, Petra
Hartl, Rainer
Glupczynski,
Youri
Huang, Te-Din
Strateva, Tanya
Marteva-Proevska, Yuliya
and Tambic Andrasevic, Arjana
Butic, Iva
Pieridou-Bagatzouni,
Despo
Maikanti-Charalampous, Panagiota
Hrabak, Jaroslav and
Zemlickova, Helena
Hammerum, Anette
Jakobsen, Lotte
Ivanova,
Marina
Pavelkovich, Anastasia
Jalava, Jari
Osterblad, Monica
and Dortet, Laurent
Vaux, Sophie
Kaase, Martin
Gatermann,
Soeren G.
Vatopoulos, Alkiviadis
Tryfinopoulou, Kyriaki and
Toth, Akos
Janvari, Laura
Boo, Teck Wee
McGrath, Elaine and
Carmeli, Yehuda
Adler, Amos
Pantosti, Annalisa
Monaco,
Monica
Raka, Lul
Kurti, Arsim
Balode, Arta
Saule, Mara
and Miciuleviciene, Jolanta
Mierauskaite, Aiste
Perrin-Weniger,
Monique
Reichert, Paul
Nestorova, Nina
Debattista, Sonia and
Mijovic, Gordana
Lopicic, Milena
Samuelsen, Orjan
Haldorsen,
Bjorg
Zabicka, Dorota
Literacka, Elzbieta
Canica, Manuela
and Manageiro, Vera
Kaftandzieva, Ana
Trajkovska-Dokic, Elena
and Damian, Maria
Lixandru, Brandusa
Jelesic, Zora
Trudic,
Anika
Niks, Milan
Schreterova, Eva
Pirs, Mateja
Cerar,
Tjasa
Oteo, Jesus
Aracil, Belen
Giske, Christian and
Sjostrom, Karin
Gur, Deniz
Cakar, Asli
Woodford, Neil and
Hopkins, Katie
Wiuff, Camilla
Brown, Derek J.
EuSCAPE
Working Grp
ESGEM Study Grp
