Hospital outbreaks of Klebsiella pneumoniae in Kathmandu, Nepal, in 2012 Graphical representation of the layout of the wards at Patan Hospital affected.

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Hospital outbreaks of Klebsiella pneumoniae in Kathmandu, Nepal, in 2012 Graphical representation of the layout of the wards at Patan Hospital affected by the 2012 K. pneumoniae outbreaks. Hospital outbreaks of Klebsiella pneumoniae in Kathmandu, Nepal, in 2012 Graphical representation of the layout of the wards at Patan Hospital affected by the 2012 K. pneumoniae outbreaks. The affected wards on the first and second floor (directly above) are highlighted in colour, which correspond with the sub‐lineages indicated in Fig 2A; nurseries and neonatal intensive care unit (NICU), orange; paediatric intensive care unit (PICU), purple; adult intensive care unit (AICU), dark green; medical ward, bright green. Plot (red line) shows the monthly ratio of Klebsiella spp. isolated from blood at Patan Hospital in 2012 with respect to Klebsiella spp. isolated from all other samples (primary y‐axis). Broken line corresponds to the mean ratio of Klebsiella spp. isolated from blood in 2012. Histogram shows the number of Klebsiella spp. isolated from blood samples at Patan Hospital per month in 2012 (secondary y‐axis). Maximum likelihood phylogeny based on core genome SNPs of the 89 K. pneumoniae isolates with the corresponding metadata: month of isolation (MON) in 2012 (see key), ward (NICU, PICU and nurseries (NICU) or other (OTH)) and specimen type from which the organism was isolated (red, blood; pink, others), antimicrobial susceptibility profile (susceptible, light grey; non‐susceptible, dark grey; and missing data, white) by disc diffusion against MEM (meropenem), IMP (imipenem), CTX (cefotaxime), CIP (ciprofloxacin), OFX (ofloxacin), GEN (gentamicin), AMK (amikacin), CHL (chloramphenicol) and SXT (trimethoprim/sulfamethoxazole). The presence (dark blue) or absence (light blue) of the pNDM‐MAR‐like plasmid and the blaNDM‐1 gene. The black arrow distinguishes the lineage with three mutations in genes associated with fluoroquinolone susceptibility (GyrA‐S83F, GyrA‐S87A, ParC‐S80I). The grey arrows identify lineages with two mutations in genes associated with fluoroquinolone susceptibility (GyrA‐S83I, ParC‐S80I). The scale bar indicates the number of nucleotide changes per site (see Materials and Methods). Hao Chung The et al. EMBO Mol Med. 2015;7:227-239 © as stated in the article, figure or figure legend