Molecular characterization of Danish ESBL/AmpC-producing Klebsiella pneumoniae from bloodstream infections, 2018

OBJECTIVES

The aim of the study was to molecularly characterize third-generation cephalosporin-resistant Klebsiella pneumoniae isolated from bloodstream infections in Denmark in 2018 using whole-genome sequencing (WGS) data, and to compare these isolates to the most common clones detected in 2006 and 2008.

METHODS

Sixty-two extended-spectrum beta-lactamase (ESBL)/AmpC-producing K. pneumoniae isolates from Danish blood cultures from 2018 were analysed using WGS to obtain multilocus sequence typing (MLST), core genome MLST (cgMLST), resistance profile and phylogeny. These were compared to the most common ESBL K. pneumoniae clones detected in 2006 and 2008.

RESULTS

The most common ESBL clone was ST15 CTX-M-15, the DHA-1 enzyme was the most common in AmpC isolates, and the OXA-48-like group was the most common carbapenemase. Thirty-nine different sequence types (STs) were found, with the most frequent being ST14, ST15 and ST37, accounting for 24% of the isolates. The isolates were subdivided into 55 complex types (CTs) of which 49 were singletons, with the most frequent being ST14-CT2080. Two of the CTX-M-15-producing isolates from 2018 belonged to the ST15-CT105/CT3078 clone, which was first detected in 2006.

CONCLUSIONS

The ESBL/AmpC K. pneumoniae isolates detected in Danish blood cultures belonged to many different types. No dominant clones were circulating in Danish hospitals, but the ST15-CT105/CT3078 CTX-M-15 K. pneumoniae clone was seen 13 years after its first detection.

Investigation of possible clonal transmission of carbapenemase-producing Klebsiella pneumoniae complex member isolates in Denmark using core genome MLST and National Patient Registry Data

OBJECTIVES

The aim of this study was to identify clonally-related carbapenemase-producing Klebsiella pneumoniae complex members that could be involved in outbreaks among hospitalized patients in Denmark, and to identify possible epidemiological links.

METHODS

From January 2014 to June 2018, 103 isolates belonging to the K. pneumoniae complex were collected from 102 patients. From the whole-genome sequencing (WGS) data, presence of genes encoding carbapenemase and multilocal sequence typing (MLST) data were extracted. Core genome MLST (cgMLST) cluster analysis was performed. Using data from the Danish National Patient Registry (DNPR) and reported travel history, presumptive outbreaks were investigated for possible epidemiological links.

RESULTS

The most common detected carbapenemase gene was bla_OXA-48, followed by bla_NDM-1. The 103 K. pneumoniae complex isolates belonged to 47 sequence types (STs) and cgMLST subdivided the isolates into 80 different complex types. cgMLST identified 13 clusters with 2-4 isolates per cluster. For five of the 13 clusters, a direct link (the patients stayed at the same ward on the same day) could be detected between at least some of the patients. In two clusters, the patients resided simultaneously at the same hospital, but not the same ward. A possible link (same ward within 1-13 days) was detected for the patients in one cluster. For five clusters detected by cgMLST, no epidemiological link could be detected using data from DNPR.

CONCLUSION

In this study, cgMLST combined with patient hospital admission data and travel information was found to be a reliable and detailed approach to detect possible clonal transmission of carbapenemase-producing K. pneumoniae complex members.

Plasmon enhanced light scattering into semiconductors by aperiodic metal nanowire arrays

Light scattering from nanostructures is an essential ingredient in several optical technologies, and experimental verification of simulations of light scattering is important. In particular, solar cells may benefit from light-trapping due to scattering. However, light that is successfully trapped in an absorbing media such as e.g. Si necessarily escapes direct detection. We present in this paper a technique for direct measurement and analysis of light scattering from nanostructures on a surface, exemplified with aperiodic patterns of Ag strips placed on a GaAs substrate. By placing the structures on the flat face of a half-cylinder, the angular distribution of light scattered into the azimuth plane can be directly detected, including directions above the critical angle that would be captured if the substrate had the form of a slab. Modelling of the scattered light by summing up contributions from each strip agrees with the experimental results to a very detailed level, both for scattering backward and into the substrate.

Near fields and far fields generated by sources in the presence of dielectric structures with cylindrical symmetry

A full-vectorial integral equation method is presented for calculating near fields and far fields generated by sources in the presence of general finite-sized dielectric structures with cylindrical symmetry. The method is relevant for modeling of a class of antenna designs and some optical components with cylindrical symmetry, e.g., vertical-cavity surface-emitting lasers, microdisk lasers, and light-emitting diodes.

Analysis of air-guiding photonic bandgap fibers

We present what is to our knowledge the first theoretical analysis of air-guiding photonic bandgap fibers. The fibers are characterized by a large hollow core and a microstructured cladding exhibiting photonic bandgap effects. Using an efficient, full-vectorial numerical method, we explain the operational principle of the fibers and obtain detailed information about the properties of the air-guided modes. This information includes accurate determination of the modes' spectral extent, cutoff properties, and mode-field distributions.

Atrial septal defect, primum type. Results of surgical closure in 46 patients

Surgical closure of an atrial septal defect of the ostium primum type was performed in 46 patients during the years 1965-78. All closures were performed with a Dacron patch and the mitral valve defect was sutured. The operative mortality was 6.5%. Pre-operatively, all patients had right bundle-branch block with left axis deviation. Severe heart block did not develop in any of the survivors. One of the patients who died had a partial atrioventricular block postoperatively. Arrhythmia developed in 5 patients, but was cardioverted to sinus rhythm. The operative technique of placing the lower sutures at the mitral valve parallel to the annulus to avoid the conduction bundle is emphasized. Repair of the tricuspid valve was performed in 10 cases and simultaneous closure of a secundum defect was made in 14. Preoperative catheterization revealed arteriovenous shunts ranging from 60 to 500% of the cardiac output. Recatheterization of 32 patients one year postoperatively showed residual shunts ranging from 20 to 75% in 5 patients who were otherwise without clinical symptoms. All survivors had a systolic apical murmur of the mitral insufficiency type.