pneumoniae (KPC-Kp) being the most common among KPC-producing CPE. Overall, the worldwide predominant carbapenemase is the Ambler class A Klebsiella pneumoniae carbapenemase (KPC) enzyme, encoded by alleles of the bla KPC gene, with KPC-producing K. The pervasive dissemination of CPE substantially impacts on patient safety since few therapeutic alternatives remain. The ongoing rise of carbapenemase-producing Enterobacterales (CPE) represents an important threat to public health worldwide, in both healthcare and community settings. Application of WGS in outbreak investigations could be useful to better understand the evolution of epidemic events in order to address infection control and contrast interventions, especially when high-risk epidemic clones are involved. Transmission of the bla KPC gene to the globally disseminated high-risk ST131 clone represents a serious cause of concern. The KPC-Ec ST131 cluster 1, originated in a previous KPC-Kp endemic context probably by plasmid transfer, and showed a clonal dissemination strategy. The remaining KPC-Ec resulted in ST978 ( n = 2/29) and ST1193 ( n = 1/29), and were bla KPC-3 associated. A further two KPC-Ec ST131 clusters were identified: cluster 2 ( n = 2/29) and cluster 3 ( n = 1/29). Phylogenomic analysis identified the ST131 cluster 1 (23/29 isolates), H30Rx clade C, as responsible for the epidemic event. Outbreak isolates showed a multidrug-resistant profile and harbored several resistance determinants, including bla CTX-M-27, aadA5, dfrA17, sulI, gyrA1AB and parC1aAB. Twenty-nine representative KPC-Ec isolates (8/29 from rectal swabs 21/29 from other clinical specimens) have been investigated by Whole-Genome Sequencing (WGS). Here we retrospectively describe the dynamics of a large hospital outbreak sustained by KPC-Ec, involving 106 patients and 25 hospital wards, during a six-month period. KPC-producing Escherichia coli (KPC-Ec) remains uncommon, being mainly reported as the cause of sporadic episodes of infection rather than outbreak events.
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