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Background  Multi-drug resistant  Klebsiella pneumoniae  strains are a common cause of health care associated infections worldwide. Clonal spread of  Klebsiella pneumoniae  isolates carrying plasmid mediated CTX-M-15 have been commonly reported. Limited data is available regarding dissemination of chromosomally encoded CTX-M-15 in  Klebsiella pneumoniae  worldwide.    Results  We examined 23 non-repetitive ESBL-producing  Klebsiella pneumoniae  strains isolated from clinical specimens over a period of 4 months in a German University Hospital. All isolates were characterized to determine their genetic relatedness using Pulsed-Field Gel Electrophoresis (PFGE) and Multi Locus Sequence Typing (MLST). PFGE revealed three clusters (B1, B2, and B3) with a sub-cluster (A3) comprising of 10 isolates with an identical PFGE pattern. All strains of the cluster B3 with similar PFGE patterns were typed as ST101, indicating an outbreak situation. The ESBL allele  bla  CTX-M-15  was identified in 16 (69.6 %) of all isolates, including all of the outbreak strains. Within the A3 sub-cluster, the CTX-M-15 allele could not be transferred by conjugation. DNA hybridization studies suggested a chromosomal location of  bla  CTX-M-15 . Whole genome sequencing located CTX-M-15 within a complete IS Ecp -1 transposition unit inserted into an ORF encoding for a putative membrane protein. PCR-based analysis of the flanking regions demonstrated that insertion into this region is unique and present in all outbreak isolates.    Conclusion  This is the first characterization of a chromosomal insertion of  bla  CTX-M-15  in  Klebsiella pneumonia  ST101, a finding suggesting that in  Enterobacteriaceae , chromosomal locations may also act as reservoirs for the spread of  bla  CTX-M-15  encoding transposition units.

bmc microbiology

Molecular epidemiology and characterization of an outbreak causing Klebsiella pneumoniae clone carrying chromosomally located bla CTX-M-15 at a German University-Hospital