pneumoniae, KPC production in other species belonging to Enterobacterales is increasingly reported. pneumoniae (KPC-Kp) being the most common among KPC-producing CPE. Overall, the worldwide predominant carbapenemase is the Ambler class A Klebsiella pneumoniae carbapenemase (KPC) enzyme, encoded by alleles of the bla KPC gene, with KPC-producing K. The pervasive dissemination of CPE substantially impacts on patient safety since few therapeutic alternatives remain. The ongoing rise of carbapenemase-producing Enterobacterales (CPE) represents an important threat to public health worldwide, in both healthcare and community settings. ![]() Application of WGS in outbreak investigations could be useful to better understand the evolution of epidemic events in order to address infection control and contrast interventions, especially when high-risk epidemic clones are involved. Transmission of the bla KPC gene to the globally disseminated high-risk ST131 clone represents a serious cause of concern. The KPC-Ec ST131 cluster 1, originated in a previous KPC-Kp endemic context probably by plasmid transfer, and showed a clonal dissemination strategy. The remaining KPC-Ec resulted in ST978 ( n = 2/29) and ST1193 ( n = 1/29), and were bla KPC-3 associated. A further two KPC-Ec ST131 clusters were identified: cluster 2 ( n = 2/29) and cluster 3 ( n = 1/29). Phylogenomic analysis identified the ST131 cluster 1 (23/29 isolates), H30Rx clade C, as responsible for the epidemic event. Outbreak isolates showed a multidrug-resistant profile and harbored several resistance determinants, including bla CTX-M-27, aadA5, dfrA17, sulI, gyrA1AB and parC1aAB. ![]() Twenty-nine representative KPC-Ec isolates (8/29 from rectal swabs 21/29 from other clinical specimens) have been investigated by Whole-Genome Sequencing (WGS). Here we retrospectively describe the dynamics of a large hospital outbreak sustained by KPC-Ec, involving 106 patients and 25 hospital wards, during a six-month period. KPC-producing Escherichia coli (KPC-Ec) remains uncommon, being mainly reported as the cause of sporadic episodes of infection rather than outbreak events.
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