A fatal outbreak of hypervirulent and multidrug resistant clone (ST2096) of Klebsiella pneumoniae silently transmitting in a Saudi Arabia western region hospital: a clinical and molecular surveillance study. ST2096 study

We identified an ongoing clonal transmission of hypervirulent MDR ST2096 K. pneumoniae strain of the cc14 followed by the global high-risk clone ST14 of the same clonal group. ST2096 transmitted silently within the hospital and was found to be associated with high mortality (58.6%). The transmission of ST2096 predominated over other sequence types until the end of our collection period on March 2018. We identified the outbreak index case arriving to the hospital on December 2016. The index case carried a hypervirulent and highly resistant K. pneumoniae ST2096 isolate had been transferred between several wards for treatments and clinical-related tests. Consequently, the transmission network model illustrated the spread of ST2096 from the ward A to the intensive care unit (ICU) and other wards that hosts long-term care patients within the hospital. The transmission network analysis and the genetic distance between isolates suggested the involvement of other unsampled isolates that could have been colonizing hospital staff or contaminating within the hospital environmental. Furthermore, the identified outbreak wards were found to be directly linked to shortage and rotation of health-care staff, antibiotic usage and patient interaction and length of stay.