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2015-05-11Zeitschriftenartikel DOI: 10.1136/bmjopen-2014-007397
What caused the outbreak of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit, Germany 2009 to 2012? Reconstructing transmission with epidemiological analysis and whole-genome sequencing
dc.contributor.authorHaller, Sebastian
dc.contributor.authorEller, Christoph
dc.contributor.authorHermes, Julia
dc.contributor.authorKaase, Martin
dc.contributor.authorSteglich, Matthias
dc.contributor.authorRadonić, Aleksandar
dc.contributor.authorDabrowski, Piotr Wojtek
dc.contributor.authorNitsche, Andreas
dc.contributor.authorPfeifer, Yvonne
dc.contributor.authorWerner, Guido
dc.contributor.authorWunderle, Werner
dc.contributor.authorVelasco, Edward
dc.contributor.authorSin, Muna Abu
dc.contributor.authorEckmanns, Tim
dc.contributor.authorNübel, Ulrich
dc.date.accessioned2018-05-07T18:14:42Z
dc.date.available2018-05-07T18:14:42Z
dc.date.created2015-05-18
dc.date.issued2015-05-11none
dc.identifier.otherhttp://edoc.rki.de/oa/articles/redc36UCfiyk/PDF/24pXXdV6KvG76.pdf
dc.identifier.urihttp://edoc.rki.de/176904/2062
dc.description.abstractObjective: We aimed to retrospectively reconstruct the timing of transmission events and pathways in order to understand why extensive preventive measures and investigations were not sufficient to prevent new cases. Methods: We extracted available information from patient charts to describe cases and to compare them to the normal population of the ward. We conducted a cohort study to identify risk factors for pathogen acquisition. We sequenced the available isolates to determine the phylogenetic relatedness of Klebsiella pneumoniae isolates on the basis of their genome sequences. Results: The investigation comprises 37 cases and the 10 cases with ESBL (extended-spectrum beta-lactamase)-producing K. pneumoniae bloodstream infection. Descriptive epidemiology indicated that a continuous transmission from person to person was most likely. Results from the cohort study showed that ‘frequent manipulation’ (a proxy for increased exposure to medical procedures) was significantly associated with being a case (RR 1.44, 95% CI 1.02 to 2.19). Genome sequences revealed that all 48 bacterial isolates available for sequencing from 31 cases were closely related (maximum genetic distance, 12 single nucleotide polymorphisms). Based on our calculation of evolutionary rate and sequence diversity, we estimate that the outbreak strain was endemic since 2008. Conclusions: Epidemiological and phylogenetic analyses consistently indicated that there were additional, undiscovered cases prior to the onset of microbiological screening and that the spread of the pathogen remained undetected over several years, driven predominantly by person-to-person transmission. Whole-genome sequencing provided valuable information on the onset, course and size of the outbreak, and on possible ways of transmission.eng
dc.language.isoeng
dc.publisherRobert Koch-Institut, Infektionskrankheiten / Erreger
dc.subjectHumanseng
dc.subjectFemaleeng
dc.subjectMaleeng
dc.subjectBiological Evolutioneng
dc.subjectGermany/epidemiologyeng
dc.subjectCohort Studieseng
dc.subjectPhylogenyeng
dc.subjectSequence Analysis DNAeng
dc.subjectGenome Bacterialeng
dc.subjectDisease Outbreakseng
dc.subjectRetrospective Studieseng
dc.subjectInfant Newborneng
dc.subjectbeta-Lactamases/metabolismeng
dc.subjectEndemic Diseaseseng
dc.subjectIntensive Care Units Neonataleng
dc.subjectKlebsiella Infections/epidemiologyeng
dc.subjectKlebsiella Infections/microbiologyeng
dc.subjectKlebsiella Infections/transmissioneng
dc.subjectKlebsiella pneumoniae/geneticseng
dc.subjectKlebsiella pneumoniae/metabolismeng
dc.subject.ddc610 Medizin
dc.titleWhat caused the outbreak of ESBL-producing Klebsiella pneumoniae in a neonatal intensive care unit, Germany 2009 to 2012? Reconstructing transmission with epidemiological analysis and whole-genome sequencing
dc.typeperiodicalPart
dc.identifier.urnurn:nbn:de:0257-10039487
dc.identifier.doi10.1136/bmjopen-2014-007397
dc.identifier.doihttp://dx.doi.org/10.25646/1987
local.edoc.container-titleBMJ Open
local.edoc.container-textHaller S, Eller C, Hermes J, et al. What caused the outbreak of ESBLproducing Klebsiella pneumoniae in a neonatal intensive care unit, Germany 2009 to 2012? Reconstructing transmission with epidemiological analysis and whole-genome sequencing. BMJ Open 2015;5:e007397.
local.edoc.fp-subtypeArtikel
local.edoc.type-nameZeitschriftenartikel
local.edoc.container-typeperiodical
local.edoc.container-type-nameZeitschrift
local.edoc.container-urlhttp://bmjopen.bmj.com/content/5/5/e007397
local.edoc.container-publisher-nameBMJ Publishing Group
local.edoc.container-volume5
local.edoc.container-issuee007397
local.edoc.container-year2015

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