Comparison of two carbapenem-resistant Klebsiella pneumoniae clones: From a contained outbreak in a paediatric population and from a national epidemic

Shmuel Benenson, Gabriela Warburg, Carlos Hidalgo-Grass, Violeta Temper, Allon E. Moses, Colin Block, Jacob Strahilevitz*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations


Objectives: A refractory epidemic of carbapenem-resistant Klebsiella pneumoniae (CRKP) emerged in the adult population at our hospital in 2005, as in most Israeli hospitals. Contemporaneously, a different clone of CRKP caused an easily contained outbreak in a paediatric long-term care facility (LTCF) in Jerusalem. While previously identified host-related risk factors for colonization by these organisms undoubtedly contributed to these outbreaks, it is very likely that bacterial factors might be crucial in explaining the striking differences in transmissibility between the implicated strains. We therefore sought bacterial factors associated with these different epidemiological behaviours. Methods: Seven CRKP isolated at our hospital and the LTCF during 2008-09 were examined by antimicrobial susceptibility testing and PFGE, and further analyses of these two clones was done using multilocus sequence typing and competition experiments. Plasmids were analysed by conjugation, restriction mapping, PCR and sequencing. Results: Both clones were multidrug resistant and harboured identical plasmids carrying the bla KPC-3 gene. The hyper-transmissible epidemic clone carried additional antibiotic resistance genes and hosted an additional plasmid. The clone from the LTCF did not demonstrate hyper-transmissible properties despite its presence in an institution of a type commonly plagued by the epidemic clone. Competition assays showed the more easily contained strain to be fitter. Conclusions: These findings suggest that neither the presence of the plasmid carrying the bla KPC-3 gene nor relative survival fitness account for the hyper-transmissibility of the epidemic strain. The role of patient age in susceptibility to colonization by the epidemic strain should be investigated.

Original languageAmerican English
Article numberdks115
Pages (from-to)1651-1654
Number of pages4
JournalJournal of Antimicrobial Chemotherapy
Issue number7
StatePublished - Jul 2012
Externally publishedYes

Bibliographical note

Funding Information:
This work was supported in part by grant Morasha 1833/07 from the Israel Science Foundation to J. S.


  • Carbapenemases
  • Competition experiments
  • Enterobacteriaceae
  • Healthcare-associated infections


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