{"doi":"10.1093/cid/ciac791","title":"Transmission of Carbapenem-Resistant <i>Klebsiella pneumoniae</i> in US Hospitals","abstract":"BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKp) is the most prevalent carbapenem-resistant Enterobacterales in the United States. We evaluated CRKp clustering in patients in US hospitals. METHODS: From April 2016 to August 2017, 350 patients with clonal group 258 CRKp were enrolled in the Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae, a prospective, multicenter, cohort study. A maximum likelihood tree was constructed using RAxML. Static clusters shared ≤21 single-nucleotide polymorphisms (SNP) and a most recent common ancestor. Dynamic clusters incorporated SNP distance, culture timing, and rates of SNP accumulation and transmission using the R program TransCluster. RESULTS: Most patients were admitted from home (n = 150, 43%) or long-term care facilities (n = 115, 33%). Urine (n = 149, 43%) was the most common isolation site. Overall, 55 static and 47 dynamics clusters were identified involving 210 of 350 (60%) and 194 of 350 (55%) patients, respectively. Approximately half of static clusters were identical to dynamic clusters. Static clusters consisted of 33 (60%) intrasystem and 22 (40%) intersystem clusters. Dynamic clusters consisted of 32 (68%) intrasystem and 15 (32%) intersystem clusters and had fewer SNP differences than static clusters (8 vs 9; P = .045; 95% confidence interval [CI]: -4 to 0). Dynamic intersystem clusters contained more patients than dynamic intrasystem clusters (median [interquartile range], 4 [2, 7] vs 2 [2, 2]; P = .007; 95% CI: -3 to 0). CONCLUSIONS: Widespread intrasystem and intersystem transmission of CRKp was identified in hospitalized US patients. Use of different methods for assessing genetic similarity resulted in only minor differences in interpretation.","journal":"Clinical Infectious Diseases","year":2022,"id":243398,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":34,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.7453,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":231557,"name":"Liang Chen","orcid":"0000-0001-5845-2235","position":1,"is_corresponding":false},{"id":234480,"name":"Lauren Komarow","orcid":null,"position":2,"is_corresponding":false},{"id":272889,"name":"Belinda Ostrowsky","orcid":null,"position":3,"is_corresponding":false},{"id":232748,"name":"Keith S. Kaye","orcid":"0000-0003-2051-1732","position":4,"is_corresponding":false},{"id":232743,"name":"Blake Hanson","orcid":"0000-0003-2949-7818","position":5,"is_corresponding":false},{"id":232742,"name":"César A. Arias","orcid":"0000-0001-9054-9774","position":6,"is_corresponding":false},{"id":619591,"name":"Samit Desai","orcid":null,"position":7,"is_corresponding":false},{"id":722325,"name":"Jason C Gallagher","orcid":"0000-0001-8532-0887","position":8,"is_corresponding":false},{"id":346136,"name":"Elizabeth Novick","orcid":null,"position":9,"is_corresponding":false},{"id":875753,"name":"Stephen Pagkalinawan","orcid":null,"position":10,"is_corresponding":false},{"id":287738,"name":"Ebbing Lautenbach","orcid":"0000-0003-4772-2409","position":11,"is_corresponding":false},{"id":554215,"name":"Glenn Wortmann","orcid":"0000-0002-7801-8871","position":12,"is_corresponding":false},{"id":281109,"name":"Robert C. Kalayjian","orcid":"0000-0001-7114-726X","position":13,"is_corresponding":false},{"id":605490,"name":"Brandon Eilertson","orcid":"0000-0002-2507-6349","position":14,"is_corresponding":false},{"id":817293,"name":"John J. Farrell","orcid":"0000-0001-6497-1090","position":15,"is_corresponding":false},{"id":491180,"name":"Todd P McCarty","orcid":null,"position":16,"is_corresponding":false},{"id":232758,"name":"Carol Hill","orcid":"0000-0001-6254-6867","position":17,"is_corresponding":false},{"id":32929,"name":"Vance G. Fowler","orcid":"0000-0002-8048-0897","position":18,"is_corresponding":false},{"id":231558,"name":"Barry N. Kreiswirth","orcid":"0000-0002-0243-131X","position":19,"is_corresponding":false},{"id":232761,"name":"Robert A. Bonomo","orcid":"0000-0002-3299-894X","position":20,"is_corresponding":false},{"id":232741,"name":"David van Duin","orcid":"0000-0003-4784-3227","position":21,"is_corresponding":false},{"id":875754,"name":"for the Multi-Drug Resistant Organism Network Investigators Network Investigators and the Antibacterial Resistance Leadership Group","orcid":null,"position":22,"is_corresponding":false},{"id":232754,"name":"Courtney Luterbach","orcid":"0000-0003-2509-0842","position":0,"is_corresponding":true}],"reference_count":45,"raw_metadata":null,"created_at":"2026-07-19T00:23:16.032700Z","pmid":"36173830","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}