{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T02:54:43Z","timestamp":1792637683125,"version":"4.5.0"},"reference-count":48,"publisher":"National Academy of Sciences","issue":"48","license":[{"start":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T00:00:00Z","timestamp":1637712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.pnas.org"],"crossmark-restriction":true},"short-container-title":["Proc. Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2021,11,30]]},"abstract":"<jats:title>Significance<\/jats:title>\n                  <jats:p>\n                    Carbapenem-resistant\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    belongs to the \u201ccritical-priority\u201d tier of bacterial pathogens as identified by the World Health Organization. Emerging \u201chigh-risk\u201d lineages are responsible for difficult-to-treat, hospital-acquired infections and outbreaks around the globe. By integrating genomic and epidemiological data for isolates collected over 20 mo, this study revealed both the high, regional prevalence and the rapid spread, within a single hospital, of\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    ST-147 in Italy. Besides resistance to nearly all antibiotics, this lineage carried a hybrid plasmid harboring a set of biomarker genes previously linked to hypervirulence. Convergence of resistance and virulence determinants is a major concern and these findings highlight the need for robust, global surveillance to monitor the emergence of high-risk\n                    <jats:italic>K. pneumoniae<\/jats:italic>\n                    .\n                  <\/jats:p>","DOI":"10.1073\/pnas.2110227118","type":"journal-article","created":{"date-parts":[[2021,11,24]],"date-time":"2021-11-24T15:01:12Z","timestamp":1637766072000},"update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":72,"title":["Anatomy of an extensively drug-resistant\n                    <i>Klebsiella pneumoniae<\/i>\n                    outbreak in Tuscany, Italy"],"prefix":"10.1073","volume":"118","author":[{"given":"Melissa J.","family":"Martin","sequence":"first","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2289-8723","authenticated-orcid":false,"given":"Brendan W.","family":"Corey","sequence":"additional","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Filomena","family":"Sannio","sequence":"additional","affiliation":[{"name":"Dipartimento di Biotecnologie Mediche, University of Siena I-53100 Siena, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6012-9899","authenticated-orcid":false,"given":"Lindsey R.","family":"Hall","sequence":"additional","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3460-7789","authenticated-orcid":false,"given":"Ulrike","family":"MacDonald","sequence":"additional","affiliation":[{"name":"Veterans Administration Western New York Healthcare System, University at Buffalo, State University of New York, Buffalo, NY 14215;"},{"name":"Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY 14203;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brendan T.","family":"Jones","sequence":"additional","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma G.","family":"Mills","sequence":"additional","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Casey","family":"Harless","sequence":"additional","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason","family":"Stam","sequence":"additional","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosslyn","family":"Maybank","sequence":"additional","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoon","family":"Kwak","sequence":"additional","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2669-8799","authenticated-orcid":false,"given":"Katharina","family":"Schaufler","sequence":"additional","affiliation":[{"name":"Institute of Pharmacy, Pharmaceutical Microbiology, University of Greifswald, 17489 Greifswald, Germany;"},{"name":"Institute of Infection Medicine, Christian-Albrecht University of Kiel, 24105 Kiel, Germany;"},{"name":"Institute of Infection Medicine, University Medical Center Schleswig-Holstein, 24105 Kiel, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6391-1341","authenticated-orcid":false,"given":"Karsten","family":"Becker","sequence":"additional","affiliation":[{"name":"Friedrich Loeffler Institute of Medical Microbiology, University of Greifswald, 17475 Greifswald, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nils-Olaf","family":"H\u00fcbner","sequence":"additional","affiliation":[{"name":"Central Unit for Infection Prevention and Control, University Medicine Greifswald, 17475 Greifswald, Germany;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefania","family":"Cresti","sequence":"additional","affiliation":[{"name":"Dipartimento di Biotecnologie Mediche, University of Siena I-53100 Siena, Italy;"},{"name":"Unita Operativa Complessa di Microbiologia e Virologia, Azienda Ospedaliera Universitaria Senese, I-53100 Siena, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacinta","family":"Tordini","sequence":"additional","affiliation":[{"name":"Dipartimento di Biotecnologie Mediche, University of Siena I-53100 Siena, Italy;"},{"name":"Unita Operativa Complessa di Microbiologia e Virologia, Azienda Ospedaliera Universitaria Senese, I-53100 Siena, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Valassina","sequence":"additional","affiliation":[{"name":"Unita Operativa Complessa di Microbiologia e Virologia, Azienda Ospedaliera Universitaria Senese, I-53100 Siena, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8869-8164","authenticated-orcid":false,"given":"Maria Grazia","family":"Cusi","sequence":"additional","affiliation":[{"name":"Dipartimento di Biotecnologie Mediche, University of Siena I-53100 Siena, Italy;"},{"name":"Unita Operativa Complessa di Microbiologia e Virologia, Azienda Ospedaliera Universitaria Senese, I-53100 Siena, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason W.","family":"Bennett","sequence":"additional","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4566-7442","authenticated-orcid":false,"given":"Thomas A.","family":"Russo","sequence":"additional","affiliation":[{"name":"Veterans Administration Western New York Healthcare System, University at Buffalo, State University of New York, Buffalo, NY 14215;"},{"name":"Department of Medicine, University at Buffalo, State University of New York, Buffalo, NY 14203;"},{"name":"Department of Microbiology and Immunology, University at Buffalo, State University of New York, Buffalo, NY 14203;"},{"name":"The Witebsky Center for Microbial Pathogenesis, University at Buffalo, State University of New York, Buffalo, NY 14203;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1548-9438","authenticated-orcid":false,"given":"Patrick T.","family":"McGann","sequence":"additional","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7157-5026","authenticated-orcid":false,"given":"Francois","family":"Lebreton","sequence":"additional","affiliation":[{"name":"Multidrug-Resistant Organism Repository and Surveillance Network, Walter Reed Army Institute of Research, Silver Spring, MD 20910;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9483-4476","authenticated-orcid":false,"given":"Jean-Denis","family":"Docquier","sequence":"additional","affiliation":[{"name":"Dipartimento di Biotecnologie Mediche, University of Siena I-53100 Siena, Italy;"},{"name":"Centre d\u2019Ing\u00e9nierie des Prot\u00e9ines-InBioS, Universit\u00e9 de Li\u00e8ge B-4000 Li\u00e8ge, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"341","published-online":{"date-parts":[[2021,11,24]]},"reference":[{"key":"e_1_3_4_1_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.11.4.589"},{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00001-19"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.00693-20"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01148-20"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41579-019-0315-1"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13073-020-00814-6"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.01750-20"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.00093-17"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(17)30489-9"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1186\/s13073-019-0706-y"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pgen.1008114"},{"key":"e_1_3_4_12_2","doi-asserted-by":"crossref","unstructured":"M. M. C. Lam A genomic surveillance framework and genotyping tool for Klebsiella pneumoniae and its related species complex. Nat. Commun . 12 4188 (2021).","DOI":"10.1038\/s41467-021-24448-3"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.000653"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms7090326"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2602.190594"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1128\/mSphere.00088-21"},{"key":"e_1_3_4_17_2","unstructured":"European Centre for Disease Prevention and Control \u201cRegional outbreak of New Delhi metallo-beta-lactamase-producing carbapenem-resistant Enterobacteriaceae Italy 2018\u20132019\u201d (ECDC 2019). https:\/\/www.ecdc.europa.eu\/sites\/default\/files\/documents\/04-Jun-2019-RRA-Carbapenems%2C%20Enterobacteriaceae-Italy.pdf. Accessed 1 December 2019."},{"key":"e_1_3_4_18_2","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2020.25.6.2000085"},{"key":"e_1_3_4_19_2","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2020.25.48.2001779"},{"key":"e_1_3_4_20_2","unstructured":"European Centre for Disease Prevention and Control (ECDC) Communicable Disease Threats Report 24 to 30 January 2021. https:\/\/www.ecdc.europa.eu\/en\/publications-data\/communicable-disease-threatsreport-24-30-january-2021-week-4. Accessed 17 November 2021."},{"key":"e_1_3_4_21_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.02817"},{"key":"e_1_3_4_22_2","doi-asserted-by":"publisher","DOI":"10.3390\/antibiotics10060691"},{"key":"e_1_3_4_23_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.03159"},{"key":"e_1_3_4_24_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jgar.2020.01.012"},{"key":"e_1_3_4_25_2","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.01945-19"},{"key":"e_1_3_4_26_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2180-11-16"},{"key":"e_1_3_4_27_2","doi-asserted-by":"publisher","DOI":"10.1093\/femspd\/ftab009"},{"key":"e_1_3_4_28_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1009376"},{"key":"e_1_3_4_29_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0049638"},{"key":"e_1_3_4_30_2","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jit384"},{"key":"e_1_3_4_31_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00776-18"},{"key":"e_1_3_4_32_2","doi-asserted-by":"publisher","DOI":"10.1128\/mSphere.00045-21"},{"key":"e_1_3_4_33_2","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2021.641415"},{"key":"e_1_3_4_34_2","doi-asserted-by":"publisher","DOI":"10.1586\/eri.12.162"},{"key":"e_1_3_4_35_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.00430-15"},{"key":"e_1_3_4_36_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.01667-13"},{"key":"e_1_3_4_37_2","doi-asserted-by":"publisher","DOI":"10.1128\/mBio.01918-14"},{"key":"e_1_3_4_38_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciy796"},{"key":"e_1_3_4_39_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.00071-20"},{"key":"e_1_3_4_40_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.immuni.2014.01.003"},{"key":"e_1_3_4_41_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0117906"},{"key":"e_1_3_4_42_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.ppat.1009537"},{"key":"e_1_3_4_43_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00840-20"},{"key":"e_1_3_4_44_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00483-19"},{"key":"e_1_3_4_45_2","first-page":"e000131","article-title":"ARIBA: Rapid antimicrobial resistance genotyping directly from sequencing reads","volume":"3","author":"Hunt M.","year":"2017","unstructured":"M. Hunt , ARIBA: Rapid antimicrobial resistance genotyping directly from sequencing reads. Microb. Genom. 3, e000131 (2017).","journal-title":"Microb. Genom."},{"key":"e_1_3_4_46_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pcbi.1003537"},{"key":"e_1_3_4_47_2","doi-asserted-by":"crossref","unstructured":"C. Rodrigues S. Desai V. Passet D. Gajjar S. Brisse Genomic evolution of the globally disseminated multidrug-resistant Klebsiella pneumoniae clonal group 147. bioRxiv [Preprint] (2021). https:\/\/doi.org\/10.1101\/2021.07.03.450759 (Accessed 5 July 2021).","DOI":"10.1101\/2021.07.03.450759"},{"key":"e_1_3_4_48_2","doi-asserted-by":"publisher","DOI":"10.1093\/bioinformatics\/btv421"}],"container-title":["Proceedings of the National Academy of Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/pnas.org\/doi\/pdf\/10.1073\/pnas.2110227118","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,4,13]],"date-time":"2022-04-13T08:10:06Z","timestamp":1649837406000},"score":1,"resource":{"primary":{"URL":"https:\/\/pnas.org\/doi\/full\/10.1073\/pnas.2110227118"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,24]]},"references-count":48,"journal-issue":{"issue":"48","published-print":{"date-parts":[[2021,11,30]]}},"alternative-id":["10.1073\/pnas.2110227118"],"URL":"https:\/\/doi.org\/10.1073\/pnas.2110227118","relation":{"has-preprint":[{"id-type":"doi","id":"10.1101\/2021.06.02.446696","asserted-by":"object"}]},"ISSN":["0027-8424","1091-6490"],"issn-type":[{"value":"0027-8424","type":"print"},{"value":"1091-6490","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,11,24]]},"assertion":[{"value":"2021-10-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-11-24","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e2110227118"}}