Genomic Dynamics of Species and Mobile Genetic Elements in a Prolonged blaIMP-4-associated Carbapenemase Outbreak in an Australian Hospital

Genome sequencing (Illumina, MinION) was used to investigate a 10-year (2006-2015) outbreak of blaIMP-4-containing organisms in a burns unit (BU) in a hospital in Sydney, Australia. 154 carbapenem non-susceptible, ESBL-producing or multi-drug resistant (MDR) isolates (58 clinical, 96 environmental) were analysed, of which 113 contained blaIMP-4. This study illustrates the persistence, diversity and evolution of genetic backgrounds disseminating blaIMP-4 amongst both human and environmental reservoirs during a prolonged outbreak.