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. 2024 Dec 23;24(1):1460.
doi: 10.1186/s12879-024-10368-2.

Nosocomial transmission of NDM-1-containing Klebsiella pneumoniae ST147 in a Dutch pediatric oncology center associated with patients from Ukraine

Wouter L Smit  1 , Herman F Wunderink  2 , Jan A J W Kluytmans  2 , Wim J E Tissing  3 , E H Pieter van Dijkhuizen  3 , Yvette G T Loeffen  4 , Antoni P A Hendrickx  5 ; Dutch CPE Surveillance Study Group
Collaborators, Affiliations

Nosocomial transmission of NDM-1-containing Klebsiella pneumoniae ST147 in a Dutch pediatric oncology center associated with patients from Ukraine

Wouter L Smit et al. BMC Infect Dis. .

Abstract

We studied nosocomial transmission of multidrug-resistant blaNDM-1-containing Klebsiella pneumoniae ST147 in a Dutch pediatric oncology center. Whole-genome multilocus sequence typing revealed two genetic clusters consisting of 2 and 5 K. pneumoniae isolates, both from Ukrainian medical evacuees and Dutch patients. Ukrainian patients were colonized at admission, and two Dutch patients developed bacteremia. Temporal and spatial transmission links were assessed and sampling of sinks revealed environmental contamination of blaNDM-1-containing K. pneumoniae with genetic relatedness to cluster isolates. Phylogenetic analysis of 163 K. pneumoniae ST147 isolates from the Dutch national surveillance revealed that transmission-related isolates formed a unique phylogenetic branch.In conclusion, we demonstrate nosocomial transmission of unique blaNDM-1-containing K. pneumoniae ST147 strains introduced by Ukrainian patients. Sink drains colonized by genetically similar blaNDM-1-containing strains in rooms designated as spatial links within the cluster were considered the potential source of transmission. Healthcare professionals should be aware of these risks, particularly in settings with susceptible patients exposed to antibiotic pressure.

Keywords: Environmental contamination; Medical evacuees; NDM-1-containing Klebsiella pneumoniae; Nosocomial transmission.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical approval was not required for the present study, since it is based on genomic and phenotypic surveillance data only. Samples from which the bacterial isolates were cultured were all taken as part of routine health care. For the patient isolates received in the Dutch CPE surveillance program (Type-Ned), patient identifiers provided by medical microbiological laboratories were encrypted and then stored in the Type-Ned database, ensuring patient privacy in accordance with General Data Protection Regulation. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Genetic and epidemiological evidence of nosocomial transmission of blaNDM-1-containing K. pneumoniae ST147. A wgMLST-based phylogenetic relatedness analysis of the nosocomial transmission cluster in context of 163 K. pneumoniae ST147 isolates submitted to the DNSS since 2017 and visualized in a minimum spanning tree. The unique cluster of patient isolates identified in the hospital is encircled with a black dotted line (green and red subclusters). A large cluster of 29 isolates as well as two small clusters associated with Ukrainian patients involved in the Dutch health care system are shown (gray nodes encircled with a blue dotted line), that are genetically distinct and not related to the nosocomial transmission cluster. B Genetic relatedness of 7 clinical isolates showing the resistome with resistance genes (upper part) and plasmids (lower part). Isolate identifiers (letters A-G) match with the patients in the Gantt chart in the supplements.C Close-up of suspected nosocomial transmission cluster showing genetic relatedness (weight of the edges) and location of prior hospitalization shown in brackets surrounded by the dashed yellow line). Numbers next to the connecting lines indicate wgMLST allelic distances
See this image and copyright information in PMC

References

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