{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T13:57:06Z","timestamp":1791899826373,"version":"4.3.4"},"reference-count":26,"publisher":"SAGE Publications","issue":"1","license":[{"start":{"date-parts":[[2014,2,1]],"date-time":"2014-02-01T00:00:00Z","timestamp":1391212800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2014,2]]},"abstract":"<jats:p>\n                    This work summarized the results obtained in an institutional\n                    <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                    surveillance program recently implemented in Cuba. Eighteen hospitals from five regions provided a total of 228\n                    <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                    isolates (164 from admitted patients, four from hospital environmental sources, and 60 isolates from community patients). The genetic relationship was assessed by pulsed-field gel electrophoresis and multilocus sequence typing. Antimicrobial susceptibility was determined by the agar dilution method, and\n                    <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                    <jats:sub>ESBL<\/jats:sub>\n                    genes were sequenced. Fifty four\n                    <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                    isolates were extended-spectrum \u03b2-lactamases (ESBL)-producers (23.6%), mostly due to the CTX-M-15 enzyme (79.6%). ESBL isolates were grouped in 27 different sequence types (STs), being the most prevalent ST15 (15%), ST152 (13%), and both ST48 and ST147 (11%, respectively). Community-acquired criteria could be demonstrated in 60 patients (26%) corresponding to urological (33%), wound (27%), respiratory (27%), and otic (13%) infections. Population structure analysis showed that our isolates corresponded to a highly polyclonal population with 10 nonpreviously described STs, demonstrating the importance of local epidemiological studies. We report the first data of the population structure of ESBL-producing\n                    <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                    isolates obtained in a national multicenter surveillance Cuban program. Results showed that a highly polyclonal ESBL-producer\n                    <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                    population was mainly due to CTX-M-15 carriage, whereas carbapenemases production was not present.\n                  <\/jats:p>","DOI":"10.1089\/mdr.2013.0021","type":"journal-article","created":{"date-parts":[[2013,5,21]],"date-time":"2013-05-21T11:29:36Z","timestamp":1369135776000},"page":"45-51","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["High Clonal Diversity in a Non-Outbreak Situation of Clinical ESBL-Producing\n                    <i>Klebsiella pneumoniae<\/i>\n                    Isolates in the First National Surveillance Program in Cuba"],"prefix":"10.1177","volume":"20","author":[{"given":"Dianelys","family":"Qui\u00f1ones","sequence":"first","affiliation":[{"name":"Instituto de Medicina Tropical Pedro Kour\u00ed","place":["Cuba"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ar\u00e1nzazu","family":"Valverde","sequence":"additional","affiliation":[{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS)","place":["Spain"]},{"name":"Universidad Complutense de Madrid","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mercedes","family":"Rodr\u00edguez-Ba\u00f1os","sequence":"additional","affiliation":[{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS)","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobumichi","family":"Kobayashi","sequence":"additional","affiliation":[{"name":"Sapporo Medical University School of Medicine","place":["Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arnaldo","family":"Zayaz","sequence":"additional","affiliation":[{"name":"Instituto de Medicina Tropical Pedro Kour\u00ed","place":["Cuba"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miriam","family":"Abreu","sequence":"additional","affiliation":[{"name":"Instituto de Medicina Tropical Pedro Kour\u00ed","place":["Cuba"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Cant\u00f3n","sequence":"additional","affiliation":[{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS)","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosa","family":"del Campo","sequence":"additional","affiliation":[{"name":"Instituto Ram\u00f3n y Cajal de Investigaci\u00f3n Sanitaria (IRYCIS)","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2014,2]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"crossref","first-page":"4565","DOI":"10.1128\/AAC.00736-12","article-title":"Clonal complex 258, the most frequently found multilocus sequence type complex in KPC-2-producing Klebsiella pneumoniae isolated in Brazilian Hospitals","volume":"56","author":"Andrade L.N.","year":"2012","unstructured":"Andrade L.N., , Curiao T., , Ferreira J.C., , Longo J.M., , Cl\u00edmaco E.C., , Martinez R., , Bellissimo-Rodrigues F., , Basile-Filho A., , Evaristo M.A., , Del Peloso P.F., , Ribeiro V.B., , Barth A.L., , Paula M.C., , Baquero F., , Cant\u00f3n R., , Darini A.L., , and Coque T.M.. 2012. Clonal complex 258, the most frequently found multilocus sequence type complex in KPC-2-producing Klebsiella pneumoniae isolated in Brazilian Hospitals. Antimicrob. Agents Chemother. 56:4565.","journal-title":"Antimicrob. Agents Chemother"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq238"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2012.03821.x"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2009.0868"},{"key":"e_1_3_3_6_2","unstructured":"[CLSI] Clinical and Laboratory Standards Institute. 2011. Performance standards for antimicrobial susceptibility testing. Document M100-S22. CLSI Wayne PA."},{"key":"e_1_3_3_7_2","doi-asserted-by":"crossref","first-page":"978","DOI":"10.1093\/jac\/dkn287","article-title":"Expansion and countrywide dissemination of ST11, ST15 and ST147 ciprofloxacin-resistant CTX-M-15-type beta-lactamase-producing Klebsiella pneumoniae epidemic clones in Hungary in 2005-the new \u2018MRSAs\u2019?","volume":"62","author":"Damjanova I.","year":"2008","unstructured":"Damjanova I., , T\u00f3th A., , P\u00e1szti J., , Hajbel-V\u00e9kony G., , Jakab M., , Berta J., , Milch H., , and F\u00fczi M.. 2008. Expansion and countrywide dissemination of ST11, ST15 and ST147 ciprofloxacin-resistant CTX-M-15-type beta-lactamase-producing Klebsiella pneumoniae epidemic clones in Hungary in 2005-the new \u2018MRSAs\u2019?. J. Antimicrob. Chemother., 62:978\u2013985.","journal-title":"J. Antimicrob. 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Microbiol."},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2010.0134"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijantimicag.2011.03.020"},{"key":"e_1_3_3_18_2","doi-asserted-by":"crossref","first-page":"3057","DOI":"10.1007\/s10096-012-1665-z","article-title":"Spread of an OmpK36-modified ST15 Klebsiella pneumoniae variant during an outbreak involving multiple carbapenem-resistant Enterobacteriaceae species and clones","volume":"31","author":"Novais A.","year":"2012","unstructured":"Novais A., , Rodrigues C., , Branquinho R., , Antunes P., , Grosso F., , Boaventura L., , Ribeiro G., , and Peixe L.. 2012. Spread of an OmpK36-modified ST15 Klebsiella pneumoniae variant during an outbreak involving multiple carbapenem-resistant Enterobacteriaceae species and clones. Eur. J. Clin. Microbiol. Infect. Dis., 31:3057\u20133063.","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"e_1_3_3_19_2","doi-asserted-by":"crossref","first-page":"524","DOI":"10.1093\/jac\/dkp211","article-title":"Emergence of CTX-M-15-producing Klebsiella pneumoniae of multilocus sequence types 1, 11, 14, 17, 20, 35 and 36 as pathogens and colonizers in newborns and adults","volume":"64","author":"Oteo J.","year":"2009","unstructured":"Oteo J., , Cuevas O., , L\u00f3pez-Rodr\u00edguez I., , Banderas-Florido A., , Vindel A., , P\u00e9rez-V\u00e1zquez M., , Bautista V., , Arroyo M., , Garc\u00eda-Caballero J., , Mar\u00edn-Casanova P., , Gonz\u00e1lez-Sanz R., , Fuentes-G\u00f3mez V., , O\u00f1a-Comp\u00e1n S., , Garc\u00eda-Cobos S., , and Campos J.. 2009. Emergence of CTX-M-15-producing Klebsiella pneumoniae of multilocus sequence types 1, 11, 14, 17, 20, 35 and 36 as pathogens and colonizers in newborns and adults. Antimicrob. Agents Chemother., 64:524\u2013528.","journal-title":"Antimicrob. 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Dis."},{"key":"e_1_3_3_23_2","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1016\/j.jinf.2011.05.003","article-title":"Comparison of CTX-M-14- and CTX-M-15-producing Escherichia coli and Klebsiella pneumoniae isolates from patients with bacteremia","volume":"63","author":"Shin J.","year":"2011","unstructured":"Shin J., , Kim D.H., , and Ko K.S.. 2011. Comparison of CTX-M-14- and CTX-M-15-producing Escherichia coli and Klebsiella pneumoniae isolates from patients with bacteremia. J. Infect., 63:39\u201347.","journal-title":"J. Infect."},{"key":"e_1_3_3_24_2","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1086\/665715","article-title":"An outbreak of extended-spectrum \u03b2-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit","volume":"33","author":"Tamma P.D.","year":"2012","unstructured":"Tamma P.D., , Savard P., , P\u00e1l T., , Sonnevend A., , Perl T. M., , and Milstone A.M.. 2012. An outbreak of extended-spectrum \u03b2-lactamase-producing Klebsiella pneumoniae in a neonatal intensive care unit. Infect. Control Hosp. Epidemiol., 33:631\u2013634.","journal-title":"Infect. Control Hosp. Epidemiol."},{"key":"e_1_3_3_25_2","doi-asserted-by":"crossref","first-page":"4769","DOI":"10.1128\/JCM.42.10.4769-4775.2004","article-title":"Dramatic increase in prevalence of fecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae during non outbreak situations in Spain","volume":"42","author":"Valverde A.","year":"2004","unstructured":"Valverde A., , Coque T.M., , S\u00e1nchez-Moreno M.P., , Roll\u00e1n A., , Baquero F., , and Cant\u00f3n R.. 2004. Dramatic increase in prevalence of fecal carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae during non outbreak situations in Spain. J. Clin. Microbiol., 42:4769\u20134775.","journal-title":"J. Clin. Microbiol."},{"key":"e_1_3_3_26_2","doi-asserted-by":"crossref","first-page":"2126","DOI":"10.1093\/jac\/dkr246","article-title":"Impact of a clonal outbreak of extended-spectrum \u03b2-lactamase-producing Klebsiella pneumoniae in the development and evolution of bloodstream infections by K. pneumoniae and Escherichia coli: an 11 year experience in Oxfordshire, UK","volume":"66","author":"Webster D.P.","year":"2011","unstructured":"Webster D.P., , Young B.C., , Morton R., , Collyer D., , Batchelor B., , Turton J.F., , Maharjan S., , Livermore D.M., , Bejon P., , Cookson B.D., , and Bowler I.C.. 2011. Impact of a clonal outbreak of extended-spectrum \u03b2-lactamase-producing Klebsiella pneumoniae in the development and evolution of bloodstream infections by K. pneumoniae and Escherichia coli: an 11 year experience in Oxfordshire, UK. J. Antimicrob. Chemother., 66:2126\u20132135.","journal-title":"J. Antimicrob. 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