Clinical data and risk factors for outbreak patients.

1)<p>Except urinary catheter.</p>2)<p>I =  admission to ICU, S =  recent surgery (laparotomi), R =  artificial ventilator use, D =  subjected to haemodialysis.</p>3)<p>Patient 1, being readmitted to SH-K, and patient 2 had been hospitalized in the same corridor for two days in March 2008 at SH-K although at separately staffed wards (Med. 2A-K and Med. 2C-K). Measures for contact isolation were not implemented for patient 1 on this occasion.</p>4)<p>Patient 4 and patient 5 had been admitted simultaneously to the ICU-A, and had also been referred to a tertiary hospital (OUS-RH) at overlapping intervals.</p>5)<p>Patient 3 and patient 4 were hospitalized in the ICU-A two days apart.</p>6)<p>LOS = length of stay (days).</p>7)<p>Overlap between patients in time and wards.</p>8)<p>Anti G-negative antibiotics prior to diagnosis</p

Molecular characteristics of outbreak strains.

1)<p>P1–6 =  clinical specimen from patients 1–6, P7/F =  fecal screen patient 7, E = specimen from environmental screen (rooms 5, 6).</p>2)<p><i>bla</i>_CTX-M was negative in all isolates. <i>bla</i>_pAmpC was negative in isolates from patients 1–6, others ND.</p>3)<p>Plasmid profiling (S1-nuclease digested DNA (kB)).</p>4)<p>Plasmid DNA hybridization with <i>bla</i>_KPC specific probes.</p

Dendrogram of XbaI-digested genomic DNA.

<p>Strains of KPC-producing <i>K. pneumoniae-</i> and <i>E.asburiae</i>-isolates and ESBL_A-producing <i>K. pneumonia</i> are shown with percentages of similarity to the right of the dendrogram.</p

PFGE of S1 nuclease-digested total DNA.

<p>Lanes 1 and 20, phage λ DNA ladder (concatemers of 48.5 kb); lane 2, K47-25; lane 3, K48-58; lane 4, K52-74; lane 5, K54-05; lane 6, K57-33; lane 7, K66-62; lane 8, K66-73; lane 9, K66-74; lane 10, K67-04; lane 11, K67-05; lane 12, K67-06; lane 13, K67-11; lane 14, K67-12; lane 15, K67-13; lane 16, K67-14; lane 17, K67-15; lane 18, K67-16; lane 19, <i>K. pneumoniae bla</i>_KPC -negative control strain.</p