(1); one isolate had VIM-2 and IMP-18, and 7 carried no metallo-beta-lactamase (MBL) gene. Single nucleotide polymorphism analysis divided the isolates into distinct clusters; the NDM-1 isolate was an outlier, and the IMP isolates and 6/7 MBL-negative isolates clustered separately from the main set of 73 VIM-2 isolates. Within the VIM-2 set, there were at least 3 distinct clusters, including a tightly clustered set of isolates from 3 hospital laboratories consistent with an outbreak from a single introduction that was quickly brought under control and a much broader set dominated by isolates from a long-running outbreak in a London hospital likely seeded from an environmental source, requiring different control measures; isolates from 7 other hospital laboratories in London and southeast England were also included. Bayesian evolutionary analysis indicated that all the isolates shared a common ancestor dating back ϳ50 years (1960s), with the main VIM-2 set separating approximately 20 to 30 years ago. Accessory gene profiling revealed blocks of genes associated with particular clusters, with some having high similarity (>95%) to bacteriophage genes. WGS of widely found international lineages such as ST-111 provides the necessary resolution to inform epidemiological investigations and intervention policies.
Concern over the increasing prevalence in hospitals of multiresistant bacteria, especially those that are resistant to carbapenem antibiotics, has prompted the use of typing methods that easily allow interlaboratory comparison of isolates. As a result, it has become clear that (i) high-risk clones of various Gram-negative bacteria, including Pseudomonas aeruginosa, can be found in many disparate locations, often with no obvious epidemiological links between the affected patients, and (ii) many of these clones are adept at acquiring various antibiotic resistance determinants (1, 2). These clones are commonly referred to as international lineages since they have been described in many countries across the globe. Epidemiological investigations of apparent outbreaks and interhospital spread of such lineages are confounded by the fact that they are so widely found; microbiological evidence of the same type must be considered alongside information about patient location and movement, for example, and patient location and movement information should be sufficiently robust to allow firm conclusions to be drawn. Greater resolution than that provided by conventional molecular typing methods, such as multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), and variable-number tandem repeat (VNTR) analysis, is essential if we are to infer or discount potential transmission pathways with confidence. Understanding these pathways will be critical for precise public health interventions to contain these highrisk clones effectively. Whole-genome sequencing (WGS) can provide this resolution and has been used to investigate outbreaks of Klebsiella pneumoniae ST-258 producing K. pneumoniae carbapenemase (KPC) enz...