{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T04:20:04Z","timestamp":1791519604938,"version":"4.3.4"},"reference-count":39,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2013,10,1]],"date-time":"2013-10-01T00:00:00Z","timestamp":1380585600000},"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":["J Clin Microbiol"],"published-print":{"date-parts":[[2013,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n          <jats:p>\n            Although numerous studies have documented outbreaks of carbapenem-resistant\n            <jats:named-content content-type=\"genus-species\">Klebsiella pneumoniae<\/jats:named-content>\n            (CRKP) possessing various carbapenemases, reports on outbreaks due to CRKP possessing extended-spectrum \u03b2-lactamases (ESBLs) and\/or AmpCs with porin lesions have been limited. Here, we describe an outbreak caused by an ertapenem-resistant, CTX-M-15-producing clonal\n            <jats:named-content content-type=\"genus-species\">K. pneumoniae<\/jats:named-content>\n            strain expressing an OmpK36 porin variant. From May 2012 to November 2012, 37 ertapenem-resistant\n            <jats:named-content content-type=\"genus-species\">K. pneumoniae<\/jats:named-content>\n            isolates phenotypically negative for carbapenemase production were recovered from 19 patients hospitalized in the intensive care unit of a Greek hospital. The isolates were either susceptible or intermediate to other carbapenems and resistant to all remaining \u03b2-lactams but cefotetan. Phenotypic and molecular analysis revealed the presence in all isolates of the\n            <jats:italic>bla<\/jats:italic>\n            <jats:sub>CTX-M-15<\/jats:sub>\n            gene on a conjugative 100-kb plasmid, disruption in the expression of the\n            <jats:italic>ompK35<\/jats:italic>\n            gene, and the production of an Ompk36 porin variant. The index case was a patient admitted from another hospital. Active surveillance upon admission and on a weekly basis was immediately initiated; environmental samples were also periodically tested. Molecular typing showed that all clinical isolates as well as two ertapenem-resistant environmental\n            <jats:named-content content-type=\"genus-species\">K. pneumoniae<\/jats:named-content>\n            isolates belonged to the same clonal type and were assigned to multilocus sequence typing (MLST) sequence type 101 (ST101). As all colonized\/infected patients were hospitalized during overlapping periods, cross-infection was considered the main route for the dissemination of the outbreak strain. Despite reinforcement of infection control measures and active surveillance, the outbreak lasted approximately 7 months. Identification of hidden carriers upon admission and by screening on a weekly basis was found valuable for early recognition and subsequent successful management of the outbreak.\n          <\/jats:p>","DOI":"10.1128\/jcm.01244-13","type":"journal-article","created":{"date-parts":[[2013,7,13]],"date-time":"2013-07-13T05:40:08Z","timestamp":1373694008000},"page":"3176-3182","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":62,"title":["Outbreak Caused by an Ertapenem-Resistant, CTX-M-15-Producing Klebsiella pneumoniae Sequence Type 101 Clone Carrying an OmpK36 Porin Variant"],"prefix":"10.1128","volume":"51","author":[{"given":"Aggeliki","family":"Poulou","sequence":"first","affiliation":[{"name":"Department of Microbiology, Serres General Hospital, Serres, Greece"},{"name":"Department of Microbiology, Medical School, University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Evangelia","family":"Voulgari","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Vrioni","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki","family":"Koumaki","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grigorios","family":"Xidopoulos","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Serres General Hospital, Serres, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasiliki","family":"Chatzipantazi","sequence":"additional","affiliation":[{"name":"Intensive Care Unit, Serres General Hospital, Serres, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fani","family":"Markou","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Serres General Hospital, Serres, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Athanassios","family":"Tsakris","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Medical School, University of Athens, Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_1_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.molmed.2012.03.003"},{"key":"e_1_3_1_3_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid1710.110655"},{"key":"e_1_3_1_4_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2012.03821.x"},{"key":"e_1_3_1_5_2","doi-asserted-by":"publisher","DOI":"10.1086\/649865"},{"key":"e_1_3_1_6_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.47.10.3332-3335.2003"},{"key":"e_1_3_1_7_2","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkp029"},{"key":"e_1_3_1_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1574-6968.2001.tb10642.x"},{"key":"e_1_3_1_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2007.01860.x"},{"key":"e_1_3_1_10_2","first-page":"62","article-title":"Carbapenem-nonsusceptible strains of Klebsiella pneumoniae producing SHV-5 and\/or DHA-1 \u03b2-lactamases in a Czech hospital","volume":"309","author":"Chud\u00e1ckov\u00e1 E","year":"2010","unstructured":"Chud\u00e1ckov\u00e1EBergerov\u00e1TFajfrl\u00edkKCerven\u00e1DUrb\u00e1skov\u00e1PEmpelJGniadkowskiMHrab\u00e1kJ. 2010. 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