The Journal of hospital infection · 2026
Hospital-wide outbreak of OXA-181-producing Klebsiella pneumoniae ST16 in Korea: an epidemiological and genomic investigation.
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Jo S, Park S H, Kim J O, Lee J S, Lee H, Lee J, Choi J-H
Аннотация
BACKGROUND: In South Korea, OXA-48-like carbapenemase-producing Enterobacterales (OXA-48-like-CPE) remain uncommon. We investigated an OXA-48-like-CPE outbreak in a Korean hospital between January and May 2025.
METHODS: We conducted integrated epidemiological and genomic investigations using contact tracing, environmental sampling, and a case-control study. Whole-genome sequencing (WGS) was performed on 23 isolates for phylogenetic analysis, with long-read sequencing of the index isolate to characterize plasmids.
RESULTS: Thirty-eight hospital-linked cases of OXA-48-like-CPE (36 cases with Klebsiella pneumoniae, one case with both K. pneumoniae and Escherichia coli, and one case with E. coli) were identified across 12 hospital wards, primarily affecting the haematology unit. The outbreak originated from a single outside case admitted to a haemato-oncology unit. Despite contact precautions, five secondary cases were linked to the index patient. The spread was further amplified by interward patient transfers, with a medical unit serving as a transmission hub, facilitating cross-departmental spread. Despite detection mainly via surveillance cultures, 10 (26.3%) patients, predominantly from haematology, developed bacteraemia. WGS confirmed clonal dissemination of OXA-181-producing K. pneumoniae sequence type 16 (OXA-181 KPN ST16), which originated from the index case and harboured the KL51 capsule and ybt10/ICEKp virulence determinants. blaOXA-181 was carried on a conserved conjugative plasmid containing multiple replicons (ColKP3, IncX3, IncFII(K), and IncFIB(K)). Intensified infection prevention and control (IPC) measures, including weekly surveillance of high-risk patients, successfully contained the outbreak within 4 months.
CONCLUSION: This outbreak highlights the potential for rapid hospital-wide dissemination of high-risk clones and underscores the critical role of integrated genomic-epidemiological investigations and intensified IPC measures in effective outbreak containment.
METHODS: We conducted integrated epidemiological and genomic investigations using contact tracing, environmental sampling, and a case-control study. Whole-genome sequencing (WGS) was performed on 23 isolates for phylogenetic analysis, with long-read sequencing of the index isolate to characterize plasmids.
RESULTS: Thirty-eight hospital-linked cases of OXA-48-like-CPE (36 cases with Klebsiella pneumoniae, one case with both K. pneumoniae and Escherichia coli, and one case with E. coli) were identified across 12 hospital wards, primarily affecting the haematology unit. The outbreak originated from a single outside case admitted to a haemato-oncology unit. Despite contact precautions, five secondary cases were linked to the index patient. The spread was further amplified by interward patient transfers, with a medical unit serving as a transmission hub, facilitating cross-departmental spread. Despite detection mainly via surveillance cultures, 10 (26.3%) patients, predominantly from haematology, developed bacteraemia. WGS confirmed clonal dissemination of OXA-181-producing K. pneumoniae sequence type 16 (OXA-181 KPN ST16), which originated from the index case and harboured the KL51 capsule and ybt10/ICEKp virulence determinants. blaOXA-181 was carried on a conserved conjugative plasmid containing multiple replicons (ColKP3, IncX3, IncFII(K), and IncFIB(K)). Intensified infection prevention and control (IPC) measures, including weekly surveillance of high-risk patients, successfully contained the outbreak within 4 months.
CONCLUSION: This outbreak highlights the potential for rapid hospital-wide dissemination of high-risk clones and underscores the critical role of integrated genomic-epidemiological investigations and intensified IPC measures in effective outbreak containment.