Background. Klebsiella pneumoniae is a human, animal, and environmental commensal and a leading cause of nosocomial infections, which are often caused by multiresistant strains. We evaluate putative sources of K. pneumoniae that are carried by and infect hospital patients.
Methods. We conducted a 6-month survey on 2 hematology wards at Addenbrooke's Hospital, Cambridge, United Kingdom, in 2015 to isolate K. pneumoniae from stool, blood, and the environment. We conducted cross-sectional surveys of K. pneumoniae from 29 livestock farms, 97 meat products, the hospital sewer, and 20 municipal wastewater treatment plants in the East of England between 2014 and 2015. Isolates were sequenced and their genomes compared.
Results. Klebsiella pneumoniae was isolated from stool of 17/149 (11%) patients and 18/922 swabs of their environment, together with 1 bloodstream infection during the study and 4 others over a 24-month period. Each patient carried 1 or more lineages that was unique to them, but 2 broad environmental contamination events and patient-environment transmission were identified. Klebsiella pneumoniae was isolated from cattle, poultry, hospital sewage, and 12/20 wastewater treatment plants. There was low genetic relatedness between isolates from patients/their hospital environment vs isolates from elsewhere. Identical genes encoding cephalosporin resistance were carried by isolates from humans/environment and elsewhere but were carried on different plasmids.
Conclusion. We identified no patient-to-patient transmission and no evidence for livestock as a source of K. pneumoniae infecting humans. However, our findings reaffirm the importance of the hospital environment as a source of K. pneumoniae associated with serious human infection.
Bibliographical noteFunding Information: This work was supported by grants from the Health Innovation Challenge Fund (grant numbers WT098600 and HICF-T5-342),a parallel funding partnership between the UK Department of Health and the Wellcome Trust. This project was also supported by a grant awarded from the Wellcome Trust (098051). T. G. is a Wellcome Trust Research Training Fellow (103387/Z/13/Z). C. L. is a Wellcome Trust Sir Henry Postdoctoral Fellow (110243/Z/15/Z). D. J. is funded by the Wellcome Trust (grant 098051).
S.J.P. and J.P. report personal fees from Next Gen Diagnostics outside the submitted work. All other authors report no potential conflicts. All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have
Open Access: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Publisher Copyright:© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America.
Citation: Catherine Ludden, Danesh Moradigaravand, Dorota Jamrozy, Theodore Gouliouris, Beth Blane, Plamena Naydenova, Juan Hernandez-Garcia, Paul Wood, Nazreen Hadjirin, Milorad Radakovic, Charles Crawley, Nicholas M Brown, Mark Holmes, Julian Parkhill, Sharon J Peacock, A One Health Study of the Genetic Relatedness of Klebsiella pneumoniae and Their Mobile Elements in the East of England, Clinical Infectious Diseases, Volume 70, Issue 2, 15 January 2020, Pages 219–226.
- Antimicrobial resistance
- Klebsiella pneumonia
- One Health