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Corbella M, Merla C, Kuka A, Mileto I, Petazzoni G, Rebuffa C, Brunco V, Gaiarsa S, Baldanti F, Cambieri P. Streptococcus pyogenes bloodstream infections in an Italian hospital: A ten-year genomic picture. J Infect Public Health 2025; 18:102701. [PMID: 39955886 DOI: 10.1016/j.jiph.2025.102701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2024] [Revised: 02/07/2025] [Accepted: 02/09/2025] [Indexed: 02/18/2025] Open
Abstract
BACKGROUND During 2022 and 2023, a large upsurge of cases of Group A Streptococcus (GAS) infection has struck many countries worldwide. This large epidemic event was caused by a diminished level of immunity after COVID-19 social restrictions and was fostered mainly by the emm1 genotype of the bacterium. METHODS We characterized the genomes of the GAS isolates that caused bloodstream infections in the last ten years in a 900-bed hospital in Northern Italy. We obtained short-read genomes, which we used for emm typing and to analyze the antimicrobial resistance and virulence gene content. Moreover, we contextualized the isolates in an epidemiological point of view using both ortholog-based and SNP-based phylogeny. RESULTS In the last ten years, we registered two upsurges of GAS cases in the study hospital: one in 2023 (in line with the global epidemiological situation), and one in 2016 (local, but observed also in another recent Italian study). The genomic analysis of the bloodstream infection isolates showed the circulation of multiple emm types, of which emm1, emm12, and emm4 characterized the two large epidemic events. Notably, the 2016 peak was mainly fostered by the M1Global and emm4 genotypes, in contrast with the rise of M1UK observed in the UK in the pre-pandemic years. Phylogeny analysis showed the presence of multiple monophyla of local strains. Despite our genomes being obtained from blood-culture isolates, we did not observe any increased presence of virulence or antimicrobial resistance genes. CONCLUSIONS Our results further confirm the role of emm1 as the most prevalent genotype worldwide. However, we also unveiled the central role of genotype emm4 in the 2016 epidemic event, described in the study hospital. Finally, our results suggest the presence of multiple locally persistent strains. Among these, we underlined the presence of a multi-drug resistant strain of emm92.
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Affiliation(s)
- Marta Corbella
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Cristina Merla
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Angela Kuka
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Specialization School of Microbiology and Virology, University of Pavia, Pavia, Italy
| | - Irene Mileto
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Specialization School of Microbiology and Virology, University of Pavia, Pavia, Italy
| | - Greta Petazzoni
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Chiara Rebuffa
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Vincenzo Brunco
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Stefano Gaiarsa
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
| | - Fausto Baldanti
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Medical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Patrizia Cambieri
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Davidova-Gerzova L, Lausova J, Sukkar I, Nechutna L, Kubackova P, Krutova M, Bezdicek M, Dolejska M. Multidrug-resistant ESBL-producing Klebsiella pneumoniae complex in Czech hospitals, wastewaters and surface waters. Antimicrob Resist Infect Control 2024; 13:141. [PMID: 39593189 PMCID: PMC11590221 DOI: 10.1186/s13756-024-01496-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 11/16/2024] [Indexed: 11/28/2024] Open
Abstract
BACKGROUND Multidrug-resistant (MDR) bacteria pose a significant challenge to the treatment of infectious diseases. Of particular concern are members of the Klebsiella pneumoniae species complex (KpSC), which are frequently associated with hospital-acquired infections and have the potential to spread outside hospitals via wastewaters. In this study, we aimed to investigate the occurrence and phylogenetic relatedness of MDR KpSC from patients with urinary tract infections (UTIs), hospital sewage, municipal wastewater treatment plants (mWWTPs) and surface waters and to evaluate the clinical relevance of the KpSC subspecies. METHODS A total of 372 KpSC isolates resistant to third-generation cephalosporins and/or meropenem were collected from patients (n = 130), hospital sewage (n = 95), inflow (n = 54) and outflow from the mWWTPs (n = 63), river upstream (n = 13) and downstream mWWTPs (n = 17) from three cities in the Czech Republic. The isolates were characterized by antimicrobial susceptibility testing and whole-genome sequencing (Illumina). The presence of antibiotic resistance genes, plasmid replicons and virulence-associated factors was determined. A phylogenetic tree and single nucleotide polymorphism matrix were created to reveal the relatedness between isolates. RESULTS The presence of MDR KpSC isolates (95%) was identified in all water sources and locations. Most isolates (99.7%) produced extended-spectrum beta-lactamases encoded by blaCTX-M-15. Resistance to carbapenems (5%) was observed mostly in wastewaters, but carbapenemase genes, such as blaGES-51 (n = 10), blaOXA-48 (n = 4), blaNDM-1 (n = 4) and blaKPC-3 (n = 1), were found in isolates from all tested locations and different sources except rivers. Among the 73 different sequence types (STs), phylogenetically related isolates were observed only among the ST307 lineage. Phylogenetic analysis revealed the transmission of this lineage from patients to the mWWTP and from the mWWTP to the adjacent river and the presence of the ST307 clone in the mWWTP over eight months. We confirmed the frequent abundance of K. pneumoniae (K. pneumoniae sensu stricto and K. pneumoniae subsp. ozaenae) in patients suffering from UTIs. K. variicola isolates formed only a minor proportion of UTIs, and K. quasipneumoniae was not found among UTIs isolates; however, these subspecies were frequently observed in hospital sewage communities during the first sampling period. CONCLUSION This study provides evidence of the transmission and persistence of the ST307 lineage from UTIs isolates via mWWTPs to surface waters. Isolates from UTIs consisted mostly of K. pneumoniae. Other isolates of KpSC were observed in hospital wastewaters, which implies the impact of sources other than UTIs. This study highlights the influence of urban wastewaters on the spread of MDR KpSC to receiving environments.
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Affiliation(s)
- Lenka Davidova-Gerzova
- Central European Institute of Technology, University of Veterinary Sciences Brno, Brno, Czech Republic
| | - Jarmila Lausova
- Central European Institute of Technology, University of Veterinary Sciences Brno, Brno, Czech Republic
- Department of Biology and Wildlife Diseases, University of Veterinary Sciences VETUNI Brno, Brno, Czech Republic
| | - Iva Sukkar
- Central European Institute of Technology, University of Veterinary Sciences Brno, Brno, Czech Republic
- Department of Microbiology, Faculty of Medicine and University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Lucie Nechutna
- Department of Microbiology, Faculty of Medicine and University Hospital Pilsen, Charles University, Pilsen, Czech Republic
- Biomedical Center, Faculty of Medicine, Charles University, Pilsen, Czech Republic
| | - Petra Kubackova
- Division of Clinical Microbiology and Immunology, Department of Laboratory Medicine, The University Hospital Brno, Brno, Czech Republic
| | - Marcela Krutova
- Department of Medical Microbiology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Matej Bezdicek
- Department of Internal Medicine-Hematology and Oncology, University Hospital Brno, Brno, Czech Republic
| | - Monika Dolejska
- Central European Institute of Technology, University of Veterinary Sciences Brno, Brno, Czech Republic.
- Department of Biology and Wildlife Diseases, University of Veterinary Sciences VETUNI Brno, Brno, Czech Republic.
- Department of Microbiology, Faculty of Medicine and University Hospital Pilsen, Charles University, Pilsen, Czech Republic.
- Division of Clinical Microbiology and Immunology, Department of Laboratory Medicine, The University Hospital Brno, Brno, Czech Republic.
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Deb S, Basu J, Choudhary M. An overview of next generation sequencing strategies and genomics tools used for tuberculosis research. J Appl Microbiol 2024; 135:lxae174. [PMID: 39003248 DOI: 10.1093/jambio/lxae174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/07/2024] [Accepted: 07/10/2024] [Indexed: 07/15/2024]
Abstract
Tuberculosis (TB) is a grave public health concern and is considered the foremost contributor to human mortality resulting from infectious disease. Due to the stringent clonality and extremely restricted genomic diversity, conventional methods prove inefficient for in-depth exploration of minor genomic variations and the evolutionary dynamics operating in Mycobacterium tuberculosis (M.tb) populations. Until now, the majority of reviews have primarily focused on delineating the application of whole-genome sequencing (WGS) in predicting antibiotic resistant genes, surveillance of drug resistance strains, and M.tb lineage classifications. Despite the growing use of next generation sequencing (NGS) and WGS analysis in TB research, there are limited studies that provide a comprehensive summary of there role in studying macroevolution, minor genetic variations, assessing mixed TB infections, and tracking transmission networks at an individual level. This highlights the need for systematic effort to fully explore the potential of WGS and its associated tools in advancing our understanding of TB epidemiology and disease transmission. We delve into the recent bioinformatics pipelines and NGS strategies that leverage various genetic features and simultaneous exploration of host-pathogen protein expression profile to decipher the genetic heterogeneity and host-pathogen interaction dynamics of the M.tb infections. This review highlights the potential benefits and limitations of NGS and bioinformatics tools and discusses their role in TB detection and epidemiology. Overall, this review could be a valuable resource for researchers and clinicians interested in NGS-based approaches in TB research.
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Affiliation(s)
- Sushanta Deb
- Department of Veterinary Microbiology and Pathology, College of Veterinary Medicine, Washington State University, Pullman 99164, WA, United States
- All India Institute of Medical Sciences, New Delhi 110029, India
| | - Jhinuk Basu
- Department of Clinical Immunology and Rheumatology, Kalinga Institute of Medical Sciences (KIMS), KIIT University, Bhubaneswar 751024, India
| | - Megha Choudhary
- All India Institute of Medical Sciences, New Delhi 110029, India
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Piazza A, Mattioni Marchetti V, Bielli A, Biffignandi GB, Piscopiello F, Giudici R, Tartaglione L, Merli M, Vismara C, Migliavacca R. A novel KPC-166 in ceftazidime/avibactam resistant ST307 Klebsiella pneumoniae causing an outbreak in intensive care COVID Unit, Italy. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2024; 57:457-469. [PMID: 38584042 DOI: 10.1016/j.jmii.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 01/31/2024] [Accepted: 03/24/2024] [Indexed: 04/09/2024]
Abstract
INTRODUCTION Aim of the study was the molecular characterization of 21 ceftazidime/avibactam resistant (CZA-R) Klebsiella pneumoniae strains, collected in the period October 2021-March 2022 from an Intensive Care COVID Unit in a Northern Italian Hospital. METHODS After growth on selective/chromogenic culture media and susceptibility tests assessment, resistance genes content was ascertained for all the isolates by the HybriSpot 12 multiplexing, PCR and Whole-Genome Sequencing (WGS). Clonality was assessed by PFGE and MLST according to the Pasteur scheme. A SNPs-based phylogenetic tree was obtained comparing representative isolates and global genomes. The blaKPC gene horizontal transmission was evaluated by conjugation experiments. blaKPC-166 was cloned in a pCR2.1 vector and transformed in chemically competent TOP10 cells. RESULTS Sixteen inpatients resulted positive for colonization and/or infection by KPC-producing K. pneumoniae (KPC-Kp) strains. The 21 CZA-R KPC-Kp isolates obtained showed MDR phenotype; susceptibility to meropenem was always retained. All the CZA-R KPC-Kp presented a novel blaKPC variant, named blaKPC-166, showing a single nucleotide substitution (T811C) compared to the blaKPC-94; but related to blaKPC-2. TWO DIFFERENT PULSOTYPES WERE DETECTED A in 18/21 and B in 1/21 cases, two strains from the same patient being untypable by PFGE. Interestingly, the outbreak was sustained by the high-risk clone ST307, although the ST22, ST6342, ST6418 and ST6811 have also been identified and associated to KPC-166. Worryingly, blaKPC-166 could be transferred horizontally and, after cloning, it conferred resistance to CZA. DISCUSSION This novel variant confers CZA-resistance and carbapenems susceptibility restoration. As KPC-166 was found expressed by multiple Kp clones, greater efforts should be made to prevent the further dissemination of such strains in Italian clinical settings.
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Affiliation(s)
- Aurora Piazza
- Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.
| | - Vittoria Mattioni Marchetti
- Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.
| | - Alessandra Bielli
- Chemical-clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | | | - Francesca Piscopiello
- Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.
| | - Riccardo Giudici
- Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Livia Tartaglione
- Chemical-clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Marco Merli
- Infectious Diseases Clinic, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Chiara Vismara
- Chemical-clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
| | - Roberta Migliavacca
- Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.
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Mileto I, Merla C, Corbella M, Gaiarsa S, Kuka A, Ghilotti S, De Cata P, Baldanti F, Cambieri P. Bloodstream Infection Caused by Erysipelothrix rhusiopathiae in an Immunocompetent Patient. Microorganisms 2024; 12:942. [PMID: 38792772 PMCID: PMC11124489 DOI: 10.3390/microorganisms12050942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/26/2024] [Accepted: 05/03/2024] [Indexed: 05/26/2024] Open
Abstract
Erysipelothrix rhusiopathiae is a facultative anaerobe Gram-positive bacillus, which is considered a zoonotic pathogen. E. rhusiopathiae causes erysipeloid, mainly in occupational groups such as veterinarians, slaughterhouse workers, farmers, and fishermen. Two cutaneous forms (localised and generalised) and a septicaemic form have been described. Here, we report the isolation of a strain of E. rhusiopathiae from a 56-year-old immunocompetent obese male admitted to Fondazione IRCCS Policlinico San Matteo Pavia (Italy). Blood cultures were collected and Gram-positive bacilli were observed. E. rhusiopathiae grew and was identified. Antimicrobial susceptibility tests were performed and interpreted with EUCAST breakpoints (PK-PD). The strain was susceptible to all the antibiotics tested, while it was intrinsically resistant to vancomycin. The clinical diagnosis of E. rhusiopathiae can be challenging, due to the broad spectrum of symptoms and potential side effects, including serious systemic infections such as heart diseases. In the case described, bacteraemia caused by E. rhusiopathiae was detected in a immunocompetent patient. Bacteraemia caused by E. rhusiopathiae is rare in immunocompetent people and blood cultures were proven to be essential for the diagnosis and underdiagnosis of this pathogen, which is possible due to its resemblance to other clinical manifestations.
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Affiliation(s)
- Irene Mileto
- Department of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Specialization School of Microbiology and Virology, University of Pavia, 27100 Pavia, Italy
| | - Cristina Merla
- Department of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Marta Corbella
- Department of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Stefano Gaiarsa
- Department of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
| | - Angela Kuka
- Department of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Specialization School of Microbiology and Virology, University of Pavia, 27100 Pavia, Italy
| | - Stefania Ghilotti
- Department of General Medicine, Istituti Clinici Maugeri IRCCS, 27100 Pavia, Italy
| | - Pasquale De Cata
- Department of General Medicine, Istituti Clinici Maugeri IRCCS, 27100 Pavia, Italy
| | - Fausto Baldanti
- Department of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
| | - Patrizia Cambieri
- Department of Microbiology & Virology, Fondazione IRCCS Policlinico San Matteo, 27100 Pavia, Italy
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Piazza A, Corbella M, Mattioni Marchetti V, Merla C, Mileto I, Kuka A, Petazzoni G, Gaiarsa S, Migliavacca R, Baldanti F, Cambieri P. Clinical isolates of ST131 blaOXA-244-positive Escherichia coli, Italy, December 2022 to July 2023. Euro Surveill 2024; 29:2400073. [PMID: 38390649 PMCID: PMC10899817 DOI: 10.2807/1560-7917.es.2024.29.8.2400073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 02/22/2024] [Indexed: 02/24/2024] Open
Abstract
The dissemination of carbapenemase-producing Escherichia coli, although still at low level, should be continuously monitored. OXA-244 is emerging in Europe, mainly in E. coli. In Italy, this carbapenemase was reported from an environmental river sample in 2019. We report clinical isolates of OXA-244-producing ST131 E. coli in four patients admitted to an acute care hospital in Pavia, Italy. The association of this difficult-to-detect determinant with a globally circulating high-risk clone, ST131 E. coli, is of clinical relevance.
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Affiliation(s)
- Aurora Piazza
- IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Marta Corbella
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Vittoria Mattioni Marchetti
- Specialization School of Microbiology and Virology, University of Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Cristina Merla
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Irene Mileto
- Specialization School of Microbiology and Virology, University of Pavia, Italy
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Angela Kuka
- Specialization School of Microbiology and Virology, University of Pavia, Italy
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Greta Petazzoni
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Stefano Gaiarsa
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Roberta Migliavacca
- IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Fausto Baldanti
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Patrizia Cambieri
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
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Mileto I, Petazzoni G, Corbella M, Gaiarsa S, Merla C, Kuka A, Ramus M, Terulla C, Brandolini M, Piralla A, Cambieri P, Baldanti F. Rapid spread of a novel NDM-producing clone of Klebsiella pneumoniae CC147, Northern Italy, February to August 2023. Euro Surveill 2023; 28:2300522. [PMID: 37855902 PMCID: PMC10588309 DOI: 10.2807/1560-7917.es.2023.28.42.2300522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 10/18/2023] [Indexed: 10/20/2023] Open
Abstract
New Delhi metallo-beta-lactamase (NDM)-producing Klebsiella pneumoniae (Kp) ST147 caused a large multi-hospital outbreak in Italy from 2018 to 2021. We describe a new ST6668 NDM-producing Kp clone, belonging to CC147, which rapidly spread across hospitals in the Pavia province (Northern Italy) from February to August 2023. Genomic analyses revealed that ST6668 is different from ST147 and fast evolving. As shown here, genomic surveillance programmes are useful for tracking the spread of new clones with reduced susceptibility to most antibiotics.
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Affiliation(s)
- Irene Mileto
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Specialization School of Microbiology and Virology, University of Pavia, Pavia, Italy
- These authors have contributed equally
| | - Greta Petazzoni
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- These authors have contributed equally
| | - Marta Corbella
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Stefano Gaiarsa
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Cristina Merla
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Angela Kuka
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Marina Ramus
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Specialization School of Microbiology and Virology, University of Pavia, Pavia, Italy
| | | | - Micaela Brandolini
- ASST Pavia, Ospedale Unificato Broni-Stradella, Internal Medicine Unit, Stradella, Italy
| | - Antonio Piralla
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Patrizia Cambieri
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- These authors contributed equally to the work and share the last authorship
| | - Fausto Baldanti
- Microbiology and Virology Unit, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- These authors contributed equally to the work and share the last authorship
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