PMID- 28935481 OWN - NLM STAT- MEDLINE DCOM- 20190314 LR - 20190314 IS - 1527-3296 (Electronic) IS - 0196-6553 (Linking) VI - 46 IP - 1 DP - 2018 Jan TI - Stalking a lethal superbug by whole-genome sequencing and phylogenetics: Influence on unraveling a major hospital outbreak of carbapenem-resistant Klebsiella pneumoniae. PG - 54-59 LID - S0196-6553(17)30909-4 [pii] LID - 10.1016/j.ajic.2017.07.022 [doi] AB - BACKGROUND: From July 2010-April 2013, Leipzig University Hospital experienced the largest outbreak of a Klebsiella pneumoniae carbapenemase 2 (KPC-2)-producing Klebsiella pneumoniae (KPC-2-Kp) strain observed in Germany to date. After termination of the outbreak, we aimed to reconstruct transmission pathways by phylogenetics based on whole-genome sequencing (WGS). METHODS: One hundred seventeen KPC-2-Kp isolates from 89 outbreak patients, 5 environmental KPC-2-Kp isolates, and 24 K pneumoniae strains not linked to the outbreak underwent WGS. Phylogenetic analysis was performed blinded to clinical data and based on the genomic reads. RESULTS: A patient from Greece was confirmed as the source of the outbreak. Transmission pathways for 11 out of 89 patients (12.4%) were plausibly explained by descriptive epidemiology, applying strict definitions. Five of these and an additional 15 (ie, 20 out of 89 patients [22.5%]) were confirmed by phylogenetics. The rate of phylogenetically confirmed transmissions increased significantly from 8 out of 66 (12.1% for the time period before) to 12 out of 23 patients (52.2% for the time period after; P <.001) after implementation of systematic screening for KPC-2-Kp (33,623 screening investigations within 11 months). Using descriptive epidemiology, systematic screening showed no significant effect (7 out of 66 [10.6%] vs 4 out of 23 [17.4%] patients; P = .465). The phylogenetic analysis supported the assumption that a contaminated positioning pillow served as a reservoir for the persistence of KPC-2-Kp. CONCLUSIONS: Effective phylogenetic identification of transmissions requires systematic microbiologic screening. Extensive screening and phylogenetic analysis based on WGS should be started as soon as possible in a bacterial outbreak situation. CI - Copyright (c) 2018 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. FAU - Kaiser, Thorsten AU - Kaiser T AD - Institute for Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics, Leipzig University Hospital, Leipzig, Germany. FAU - Finstermeier, Knut AU - Finstermeier K AD - Institute for Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics, Leipzig University Hospital, Leipzig, Germany. FAU - Hantzsch, Madlen AU - Hantzsch M AD - Institute for Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics, Leipzig University Hospital, Leipzig, Germany. FAU - Faucheux, Sarah AU - Faucheux S AD - Institute for Hospital Hygiene, Leipzig University Hospital, Leipzig, Germany. FAU - Kaase, Martin AU - Kaase M AD - Department of Medical Microbiology, National Reference Center for Multidrug-Resistant Gram-negative Bacteria, Ruhr University Bochum, Bochum, Germany. FAU - Eckmanns, Tim AU - Eckmanns T AD - Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany. FAU - Bercker, Sven AU - Bercker S AD - Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital, Leipzig, Germany. FAU - Kaisers, Udo X AU - Kaisers UX AD - Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital, Leipzig, Germany. FAU - Lippmann, Norman AU - Lippmann N AD - Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany; Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany. FAU - Rodloff, Arne C AU - Rodloff AC AD - Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany; Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany. FAU - Thiery, Joachim AU - Thiery J AD - Institute for Laboratory Medicine, Clinical Chemistry, and Molecular Diagnostics, Leipzig University Hospital, Leipzig, Germany. FAU - Lubbert, Christoph AU - Lubbert C AD - Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany; Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany. Electronic address: christoph.luebbert@medizin.uni-leipzig.de. LA - eng PT - Journal Article DEP - 20170919 PL - United States TA - Am J Infect Control JT - American journal of infection control JID - 8004854 RN - 0 (Carbapenems) SB - IM MH - Carbapenems/*pharmacology MH - Disease Outbreaks MH - Drug Resistance, Multiple, Bacterial/*genetics MH - *Genome, Bacterial MH - Germany/epidemiology MH - Hospitals MH - Humans MH - Klebsiella Infections/epidemiology/*microbiology/mortality MH - Klebsiella pneumoniae/*drug effects/genetics MH - Molecular Epidemiology MH - *Phylogeny MH - Retrospective Studies OTO - NOTNLM OT - Carbapenemase OT - Colonization OT - Enterobacteriaceae OT - Epidemiologic analysis OT - Infection OT - Klebsiella pneumoniae OT - Microbiologic screening EDAT- 2017/09/25 06:00 MHDA- 2019/03/15 06:00 CRDT- 2017/09/23 06:00 PHST- 2017/05/21 00:00 [received] PHST- 2017/07/24 00:00 [revised] PHST- 2017/07/24 00:00 [accepted] PHST- 2017/09/25 06:00 [pubmed] PHST- 2019/03/15 06:00 [medline] PHST- 2017/09/23 06:00 [entrez] AID - S0196-6553(17)30909-4 [pii] AID - 10.1016/j.ajic.2017.07.022 [doi] PST - ppublish SO - Am J Infect Control. 2018 Jan;46(1):54-59. doi: 10.1016/j.ajic.2017.07.022. Epub 2017 Sep 19.