{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T09:30:53Z","timestamp":1787909453136,"version":"build-2784847793"},"reference-count":47,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T00:00:00Z","timestamp":1761091200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["32170003, 32370099"],"award-info":[{"award-number":["32170003, 32370099"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100019978","name":"Shanghai Pudong New Area Health Commission","doi-asserted-by":"publisher","award":["PW2023D-03"],"award-info":[{"award-number":["PW2023D-03"]}],"id":[{"id":"10.13039\/501100019978","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004608","name":"Natural Science Foundation of Jiangsu Province","doi-asserted-by":"publisher","award":["BK20211311"],"award-info":[{"award-number":["BK20211311"]}],"id":[{"id":"10.13039\/501100004608","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82202465"],"award-info":[{"award-number":["82202465"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["mSystems"],"published-print":{"date-parts":[[2025,10,22]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Healthcare-associated infections (HAIs), particularly in neonatal intensive\n                        care units (NICUs), pose significant challenges due to neonates\u2019\n                        vulnerability and the rapid infection spread. However, risk factors\n                        facilitating pathogen persistence and dissemination have not been\n                        comprehensively investigated. This study aims to track HAI transmission\n                        pathways in NICUs and identify key risk factors contributing to the\n                        persistence and spread of carbapenem-resistant\n                      <jats:italic toggle=\"yes\">Klebsiella\n                            pneumoniae<\/jats:italic>\n                      (CRKP). We analyzed CRKP epidemiology and population\n                        dynamics in neonatal patients at a pediatric hospital in China over 8 years.\n                        Random forest models identified primary risk factors for CRKP persistence\n                        and outbreaks, focusing on clonal spread, healthcare groups (HGs), and\n                        plasmid dynamics. Three major clonal outbreaks involving ST14 and ST433\n                        strains were identified, highlighting the critical role of clonal\n                        dissemination in NICUs. Complex transmission patterns, characterized by\n                        periods of dormancy and resurgence, suggest the existence of underlying\n                        reservoirs. HGs were implicated in the short-term transmission of CRKP, with\n                        &gt;80% of infection clusters involving patients from the same HG.\n                        Plasmids emerged as critical factors in the long-term persistence of CRKP,\n                        with shifts in plasmid prevalence corresponding to outbreak periods. This\n                        study advances our understanding of CRKP transmission dynamics in NICUs,\n                        highlighting the multifaceted roles of clonal dissemination, HGs, and\n                        plasmid-mediated persistence. Our findings emphasize the need for enhanced\n                        infection control measures targeting both intra- and inter-group\n                        transmissions and plasmid surveillance.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        This study provides a detailed analysis of carbapenem-resistant\n                        <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                        (CRKP) transmission dynamics\n                            in neonatal intensive care units (NICUs) over eight years, utilizing 64\n                            isolates and applying machine learning to identify risk factors\n                            associated with persistence and spread. Through phylogenetic analyses,\n                            we uncovered three clonal outbreaks and linked healthcare group (HG)\n                            interactions, bacterial genotypes, and plasmid prevalence to short- and\n                            long-term CRKP transmission. We identified that HGs are primary\n                            mediators of rapid, short-term transmission, while specific plasmids\n                            play an extended role in maintaining CRKP presence across multiple\n                            patient cohorts and bacterial strains. This finding suggests the\n                            existence of latent reservoirs or periodic reintroductions from external\n                            sources, thus reshaping the understanding of NICU-associated pathogen\n                            transmission and persistence.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/msystems.00909-25","type":"journal-article","created":{"date-parts":[[2025,9,15]],"date-time":"2025-09-15T13:00:45Z","timestamp":1757941245000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":4,"title":["Machine learning-based evaluation of risk factors for                    carbapenem-resistant\n                    <i>Klebsiella pneumoniae<\/i>\n                    dissemination in                    neonatal units"],"prefix":"10.1128","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-7336-0194","authenticated-orcid":true,"given":"Xiao","family":"Liu","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01tc10z29","id-type":"ROR","asserted-by":"publisher"}],"name":"Key Laboratory of Alkene-carbon Fibres-based Technology & Application for Detection of Major Infectious Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Cancer Institute, Suzhou Medical College, Soochow University","place":["Suzhou, China"]},{"id":[{"id":"https:\/\/ror.org\/04wktzw65","id-type":"ROR","asserted-by":"publisher"}],"name":"National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4076-8394","authenticated-orcid":true,"given":"Muxiu","family":"Jiang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/0220qvk04","id-type":"ROR","asserted-by":"publisher"}],"name":"Department of Infectious Disease, Shanghai Children\u2019s Medical Center, School of Medicine, Shanghai Jiao Tong University","place":["Shanghai, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinzhi","family":"Zhang","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/03k14e164","id-type":"ROR","asserted-by":"publisher"}],"name":"Emergency and Critical Care Center, Intensive Care Unit, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng","family":"Li","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01tc10z29","id-type":"ROR","asserted-by":"publisher"}],"name":"Key Laboratory of Alkene-carbon Fibres-based Technology & Application for Detection of Major Infectious Diseases, MOE Key Laboratory of Geriatric Diseases and Immunology, Cancer Institute, Suzhou Medical College, Soochow University","place":["Suzhou, China"]},{"id":[{"id":"https:\/\/ror.org\/05kvm7n82","id-type":"ROR","asserted-by":"publisher"}],"name":"Jiangsu Province Engineering Research Center of Precision Diagnostics and Therapeutics Development, Soochow University","place":["Suzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yina","family":"Liu","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/01tc10z29","id-type":"ROR","asserted-by":"publisher"}],"name":"Key Laboratory of Alkene-carbon Fibres-based 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