{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T18:35:58Z","timestamp":1791311758919,"version":"4.3.1"},"reference-count":49,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2015,2,11]],"date-time":"2015-02-11T00:00:00Z","timestamp":1423612800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/3.0\/"},{"start":{"date-parts":[[2015,3,1]],"date-time":"2015-03-01T00:00:00Z","timestamp":1425168000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2015,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            The global emergence of\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Klebsiella pneumoniae<\/jats:named-content>\n            carbapenemase-producing\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n            (KPC-\n            <jats:italic>Kp<\/jats:italic>\n            ) multilocus sequence type ST258 is widely recognized. Less is known about the molecular and epidemiological details of non-ST258\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n            in the setting of an outbreak mediated by an endemic plasmid. We describe the interplay of\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            plasmids and\n            <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n            strains and their relationship to the location of acquisition in a U.S. health care institution. Whole-genome sequencing (WGS) analysis was applied to KPC-\n            <jats:italic>Kp<\/jats:italic>\n            clinical isolates collected from a single institution over 5 years following the introduction of\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            in August 2007, as well as two plasmid transformants. KPC-\n            <jats:italic>Kp<\/jats:italic>\n            from 37 patients yielded 16 distinct sequence types (STs). Two novel conjugative\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            plasmids (pKPC_UVA01 and pKPC_UVA02), carried by the hospital index case, accounted for the presence of\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            in 21\/37 (57%) subsequent cases. Thirteen (35%) isolates represented an emergent lineage, ST941, which contained pKPC_UVA01 in 5\/13 (38%) and pKPC_UVA02 in 6\/13 (46%) cases. Seven (19%) isolates were the epidemic KPC-\n            <jats:italic>Kp<\/jats:italic>\n            strain, ST258, mostly imported from elsewhere and not carrying pKPC_UVA01 or pKPC_UVA02. Using WGS-based analysis of clinical isolates and plasmid transformants, we demonstrate the unexpected dispersal of\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            to many non-ST258 lineages in a hospital through spread of at least two novel\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            plasmids. In contrast, ST258 KPC-\n            <jats:italic>Kp<\/jats:italic>\n            was imported into the institution on numerous occasions, with other\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            plasmid vectors and without sustained transmission. Instead, a newly recognized KPC-\n            <jats:italic>Kp<\/jats:italic>\n            strain, ST941, became associated with both novel\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>KPC<\/jats:sub>\n            plasmids and spread locally, making it a future candidate for clinical persistence and dissemination.\n          <\/jats:p>","DOI":"10.1128\/aac.04292-14","type":"journal-article","created":{"date-parts":[[2015,1,6]],"date-time":"2015-01-06T03:55:44Z","timestamp":1420516544000},"page":"1656-1663","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":142,"title":["Klebsiella pneumoniae Carbapenemase (KPC)-Producing K. pneumoniae at a Single Institution: Insights into Endemicity from Whole-Genome Sequencing"],"prefix":"10.1128","volume":"59","author":[{"given":"Amy J.","family":"Mathers","sequence":"first","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA"},{"name":"Clinical Microbiology, Department of Pathology, University of Virginia Health System, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicole","family":"Stoesser","sequence":"additional","affiliation":[{"name":"Modernizing Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna E.","family":"Sheppard","sequence":"additional","affiliation":[{"name":"Modernizing Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louise","family":"Pankhurst","sequence":"additional","affiliation":[{"name":"Modernizing Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"Giess","sequence":"additional","affiliation":[{"name":"Modernizing Medical Microbiology Consortium, Nuffield Department of Clinical Medicine, John Radcliffe Hospital, Oxford University, Oxford, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony J.","family":"Yeh","sequence":"additional","affiliation":[{"name":"Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xavier","family":"Didelot","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, London, United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen D.","family":"Turner","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, School of Medicine, University of Virginia, Charlottesville, Virginia, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Sebra","sequence":"additional","affiliation":[{"name":"Icahn Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Kasarskis","sequence":"additional","affiliation":[{"name":"Icahn Institute and Department of Genetics and Genomic Sciences, Icahn School of Medicine, Mount Sinai, New York, New York, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Peto","sequence":"additional","affiliation":[{"name":"Modernizing Medical Microbiology Consortium, Nuffield Department 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