Figure 4
Space–time monthly distribution of patients harboring the carbapenem-resistant K. pneumoniae (CR-Kp) species complex and flow of cases (1–8) with polymyxin-carbapenem-resistant K. pneumoniae (PCR-Kp), by the hospital’s Geographic Information System17. Thematic hospital map in QGIS format (version 2.18, Open-Source Geospatial Foundation), federal tertiary hospital, Rio de Janeiro, December 2014 to August 201517. The ward number is positioned in the center of its respective physical area. Patient numbers in red (ST437 PCR-Kp cases) or blue circles (ST11 PCR-Kp cases) ordered by the date of strain detection. K. pneumoniae complex isolate screened by the Vitek-2 system as PCR phenotype from case 5 (pink circle) was not preserved, but its AMR pattern (see Supplementary Table 2) was compatible with ST437 strains. The blue and red arrows represent the transfer of PCR-Kp infected cases before and after the detection of the PCR-Kp isolate, respectively. The dashed red arrow indicates that this patient was likely carrying PCR-Kp, although it had not yet been detected (see Table 1, PCR-Kp of cases 1 and 2 forms a subcluster of transmission). The dashed black arrow indicates that wards pertain to the same clinic or work as the same ICU. None of the cases had the opportunity for direct transmission to another case, considering the hospitalization unit and period. Superscript a: the number of patients in each ward or unit was counted monthly for the period of hospitalization after the first detection of CR-Kp complex.
