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Natl. Acad. Sci. U.S.A."],"published-print":{"date-parts":[[2020,10,6]]},"abstract":"<jats:title>Significance<\/jats:title>\n          <jats:p>\n            In many clinically important bacteria, antibiotic resistance genes are primarily carried on plasmids. These can spread horizontally between different strains and species. However, current surveillance systems track chromosomal lineages of bacteria only, leading to an incomplete understanding of how resistance spreads, from within an individual hospital to across country borders. We present an integrated, high-resolution analysis of both chromosome and plasmid sequences using\n            <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n            isolates sampled during a European survey. We show that carbapenemase genes, which confer resistance to last-line antibiotics, have spread in diverse ways including via one plasmid\/multiple lineages (\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>OXA-48-like<\/jats:sub>\n            ), multiple plasmids\/multiple lineages (\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>VIM<\/jats:sub>\n            ,\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>NDM<\/jats:sub>\n            ), and multiple plasmids\/one lineage (\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            ). These different trajectories must be considered in genomic surveillance systems and the design of new interventions.\n          <\/jats:p>","DOI":"10.1073\/pnas.2003407117","type":"journal-article","created":{"date-parts":[[2020,9,24]],"date-time":"2020-09-24T01:27:19Z","timestamp":1600910839000},"page":"25043-25054","update-policy":"https:\/\/doi.org\/10.1073\/pnas.cm10313","source":"Crossref","is-referenced-by-count":154,"title":["Integrated chromosomal and plasmid sequence analyses reveal diverse modes of carbapenemase gene spread among\n            <i>Klebsiella pneumoniae<\/i>"],"prefix":"10.1073","volume":"117","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0115-0954","authenticated-orcid":false,"given":"Sophia","family":"David","sequence":"first","affiliation":[{"name":"Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, CB10 1SA Cambridge, United 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J.","family":"Feil","sequence":"additional","affiliation":[{"name":"Milner Centre for Evolution, Department of Biology and Biochemistry, University of Bath, Bath BA2 7AY, United Kingdom;"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9971-522X","authenticated-orcid":false,"given":"Hajo","family":"Grundmann","sequence":"additional","affiliation":[{"name":"Institute for Infection Prevention and Hospital Epidemiology, Medical Centre, University of Freiburg, 79106 Freiburg, Germany;"},{"name":"Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany;"}]},{"given":"David M.","family":"Aanensen","sequence":"additional","affiliation":[{"name":"Centre for Genomic Pathogen Surveillance, Wellcome Genome Campus, Hinxton, CB10 1SA Cambridge, United Kingdom;"},{"name":"Big Data Institute, Li Ka Shing Centre for Health Information and Discovery, Nuffield Department of Medicine, Oxford University, Oxford OX3 7LF, United 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