{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T12:02:35Z","timestamp":1789732955282,"version":"4.0.1"},"reference-count":60,"publisher":"American Society for Microbiology","issue":"1","license":[{"start":{"date-parts":[[2017,2,21]],"date-time":"2017-02-21T00:00:00Z","timestamp":1487635200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2017,3,8]],"date-time":"2017-03-08T00:00:00Z","timestamp":1488931200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100000276","name":"UK department of health","doi-asserted-by":"crossref","award":["HICF-T5-342 and WT098600"],"award-info":[{"award-number":["HICF-T5-342 and WT098600"]}],"id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["098051"],"award-info":[{"award-number":["098051"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["mBio"],"published-print":{"date-parts":[[2017,3,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    is a human commensal and opportunistic pathogen that has become a leading causative agent of hospital-based infections over the past few decades. The emergence and global expansion of hypervirulent and multidrug-resistant (MDR) clones of\n                    <jats:italic>K.\u00a0pneumoniae<\/jats:italic>\n                    have been increasingly reported in community-acquired and nosocomial infections. Despite this, the population genomics and epidemiology of MDR\n                    <jats:italic>K.\u00a0pneumoniae<\/jats:italic>\n                    at the national level are still poorly understood. To obtain insights into these, we analyzed a systematic large-scale collection of invasive MDR\n                    <jats:italic>K.\u00a0pneumoniae<\/jats:italic>\n                    isolates from hospitals across the United Kingdom and Ireland. Using whole-genome phylogenetic analysis, we placed these in the context of previously sequenced\n                    <jats:italic>K.\u00a0pneumoniae<\/jats:italic>\n                    populations from geographically diverse countries and identified their virulence and drug resistance determinants. Our results demonstrate that United Kingdom and Ireland MDR isolates are a highly diverse population drawn from across the global phylogenetic tree of\n                    <jats:italic>K.\u00a0pneumoniae<\/jats:italic>\n                    and represent multiple recent international introductions that are mainly from Europe but in some cases from more distant countries. In addition, we identified novel genetic determinants underlying resistance to beta-lactams, gentamicin, ciprofloxacin, and tetracyclines, indicating that both increased virulence and resistance have emerged independently multiple times throughout the population. Our data show that MDR\n                    <jats:italic>K.\u00a0pneumoniae<\/jats:italic>\n                    isolates in the United Kingdom and Ireland have multiple distinct origins and appear to be part of a globally circulating\n                    <jats:italic>K.\u00a0pneumoniae<\/jats:italic>\n                    population.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>IMPORTANCE<\/jats:bold>\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    is a major human pathogen that has been implicated in infections in healthcare settings over the past few decades. Antimicrobial treatment of\n                    <jats:italic>K.\u00a0pneumoniae<\/jats:italic>\n                    infections has become increasingly difficult as a consequence of the emergence and spread of strains that are resistant to multiple antimicrobials. To better understand the spread of resistant\n                    <jats:italic>K.\u00a0pneumoniae<\/jats:italic>\n                    , we studied the genomes of a large-scale population of extensively antimicrobial-resistant\n                    <jats:italic>K.\u00a0pneumoniae<\/jats:italic>\n                    in the United Kingdom and Ireland by utilizing the fine resolution that whole-genome sequencing of pathogen genomes provides. Our results indicate that the\n                    <jats:italic>K.\u00a0pneumoniae<\/jats:italic>\n                    population is highly diverse and that, in some cases, resistant strains appear to have spread across the country over a few years. In addition, we found evidence that some strains have acquired antimicrobial resistance genes independently, presumably in response to antimicrobial treatment.\n                  <\/jats:p>","DOI":"10.1128\/mbio.01976-16","type":"journal-article","created":{"date-parts":[[2017,2,21]],"date-time":"2017-02-21T20:10:23Z","timestamp":1487707823000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":122,"title":["Evolution and Epidemiology of Multidrug-Resistant\n                    <i>Klebsiella pneumoniae<\/i>\n                    in the United Kingdom and Ireland"],"prefix":"10.1128","volume":"8","author":[{"given":"Danesh","family":"Moradigaravand","sequence":"first","affiliation":[{"name":"Wellcome Trust Sanger Institute, Wellcome Genome Campus, Hinxton, Cambridgeshire, United 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