A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study

Gu, Danxia; Dong, Ning; Zheng, Zhiwei; Lin, Di; Huang, Man; Wang, Lihua; Chan, Edward Wai-Chi; Shu, Lingbin; Yu, Jiang; Zhang, Rong; Chen, Sheng

doi:10.1016/s1473-3099(17)30489-9

Cited by 780 publications

(950 citation statements)

References 29 publications

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“…Although the horizontal transfer of resistance plasmids harboring the bla KPC-2 gene to E. coli [12] or ST65 HvKP [24] was confirmed through conjugation experiments, it did not examine whether the pLVPK-like plasmid of HvKP can be transferred to CRKP through conjugation. There is only one plasmid sequence (AY378100) of pLVPK or pLVPK-like plasmid deposited in GenBank.…”

Section: Scope For Further Studiesmentioning

confidence: 99%

“…However, only 36% (15 of 41) of CR-HvKP isolates belonged to the K1/K2 capsule type (Table 1). Danxia et al showed that ST11 CRKP strains with the K47 capsular serotype exhibit the hypervirulent phenotype only by acquiring the pLVPK-like plasmid [12]. Therefore, these results imply that more extensive studies are required to exactly establish the relationship between hypervirulence and the K1/K2 capsular type.…”

Section: Issn 0970-938x Wwwbiomedresinfomentioning

confidence: 99%

“…Especially, the emergence of Carbapenem-Resistant HvKP (CR-HvKP) was reported in China, where both carbapenem-resistant cKP (CRKP) and carbapenemsusceptible HvKP strains are prevalent [6,11]. A recent study performed by Danxia et al showed the emergence of CRHvKP ST11 strains caused by the transfer of a 170 kb pLVPKlike virulence plasmid into bla KPC-2 -harboring ST11 CRKP stains [12]. The report provided a direct clue to plasmidmediated convergence of carbapenem-resistance and hypervirulence.…”

Section: Introductionmentioning

confidence: 99%

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The threat of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-HvKP)

Lee¹,

Park²,

Lee³

et al. 2018

biomedicalresearch

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Klebsiella pneumoniae is one of clinically important opportunistic pathogens responsible for community-acquired and nosocomial infections in immunocompromised individuals. The increasing prevalence of carbapenem-resistant K. pneumoniae (CRKP) poses a serious threat to public health worldwide. With antibiotic resistance, hypervirulent K. pneumoniae (HvKP) responsible for serious disseminated infections in both healthy and immunocompromised individuals has also emerged. Recently, the emergence of carbapenem-resistant hypervirulent K. pneumoniae (CR-HvKP) strains has become a great challenge to public health. In this paper, we discuss the emergence mechanisms of CRHvKP through analyzing features of CR-HvKP strains isolated in China, where both CRKP and HvKP strains are prevalent. These analyses suggest that more extensive surveillance is required to accurately assess the potential threat of the plasmid-mediated convergence of carbapenem-resistance and hypervirulence.

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Section: Scope For Further Studiesmentioning

confidence: 99%

Section: Issn 0970-938x Wwwbiomedresinfomentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The threat of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-HvKP)

Lee¹,

Park²,

Lee³

et al. 2018

biomedicalresearch

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show abstract

“…The appearance and rapid spread of antibiotic multiresistant strains, and the appearance of hypervirulent strains in Asia, make this bacterium a worldwide concern . In fact, a recent outbreak in China of high morbidity and mortality was caused by a hypervirulent K. pneumoniae strain resistant to carbapenems …”

Section: The Key Role Of Mdscs During Bacterial Viral and Parasiticmentioning

confidence: 99%

The role of myeloid-derived suppressor cells in chronic infectious diseases and the current methodology available for their study

Peñaloza

Álvarez

Muñoz‐Durango

et al. 2018

Journal of Leukocyte Biology

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An effective pathogen has the ability to evade the immune response. The strategies used to achieve this may be based on the direct action of virulence factors or on the induction of host factors. Myeloid‐derived suppressor cells (MDSCs) are immune cells with an incredible ability to suppress the inflammatory response, which makes them excellent targets to be exploited by pathogenic bacteria, viruses, or parasites. In this review, we describe the origin and suppressive mechanisms of MDSCs, as well as their role in chronic bacterial, viral, and parasitic infections, where their expansion seems to be essential in the chronicity of the disease. We also analyze the disadvantages of current MDSC depletion strategies and the different in vitro generation methods, which can be useful tools for the deeper study of these cells in the context of microbial infections.

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“…As the frequently reported pathogen among the donor-transmitted infections associated with kidney transplantation from DCD, Carbapenem resistant Klebsiella pneumonia (CRKP) is a Gram-negative bacterial pathogen responsible for severe diseases, such as septicemia, pneumoniae, urinary tract infection and soft tissue infection, associated with community and hospital acquired infection [5], and characterized by high mortality, high transmissibility and multidrug resistance [6]. It has been reported that high mortality rates, ranging from 20 to 40%, were related to patients with Klebsiella pneumonia bloodstream infection (KP-BSI) [7], but this mortality was reported to rise up to 67.6% for intensive care unit (ICU) patients [8].…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of carbapenem-resistant Klebsiella pneumoniae bloodstream infections after renal transplantation from donation after cardiac death in a Chinese hospital: a case series analysis

Wang

Hong

Zhang

et al. 2018

Antimicrob Resist Infect Control

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BackgroundAlthough the high mortality rates have been extensively reported worldwide, few studies have investigated the epidemiology of CRKP-BSIs in the early stage after kidney transplantation (KTx) from donation after cardiac death (DCD). We sought to describe the epidemiological and clinical characteristics of cases of carbapenem resistant Klebsiella pneumoniae bloodstream infections (CRKP-BSIs) in kidney transplantation recipients (KTRs) from DCD in our hospital.MethodsA retrospective analysis of clinical data of CRKP-BSIs in KTRs admitted to a Chinese hospital in Beijing, China, between January 1, 2012 and December 31, 2016 was performed. The annual percentage of patients with CRKP, the annual number of total KTRs and KTRs from DCD were determined. The genetic relatedness of the strains was determined by polymerase chain reaction and pulse field gel electrophoresis (PFGE).ResultsDuring the study period, there were total 947 KTRs in our hospital, including 275 KTRs from DCD. Five incidences of CRKP-BSIs in KTRs were identified, and two of them (Case 1,3) from the same foreign hospital. The incidence of CRKP-BSIs in the early stage (within 3 months) following kidney transplantation (KTx) from DCD was about 1.1% (3/275). In Case 1–3 and 5, the rupture of renal transplant artery was presented on the 40th, 16th, 43th and 74th day after KTx, and in Case 4, the thrombus of renal transplant artery was presented on the 13th day after KTx. Three cases (Case 1,2,5) occurring pneumothorax on the 45th, 51th and 32th day after KTx. Four cases (Case 1–4) received the excision of the transplanted kidney for the treatment. Polymerase chain reaction showed the bands for case 2 were distinctive from other cases. Pulse field gel electrophoresis showed mainly three clusters of the bands for all the isolates.ConclusionsDuring the study period, we observed an increase in the occurrence of CRKP-BSIs among KTRs from DCD in our hospital. We demonstrated that rupture/thrombus of the renal transplant artery was associated with CRKP-BSI in the early stage after KTx from DCD. Albeit the low incidence of CRKP-BSI (1.1%) after KTx from DCD, the high mortality (4/5) had been observed from the prognosis of the patients. Thorough surveillance of DCD donors, early identification of CRKP-BSI, necessary preventative measurements and use of appropriate treatments should be the strategy for CRKP-BSI in the early stage after KTx from DCD.Electronic supplementary materialThe online version of this article (10.1186/s13756-018-0355-8) contains supplementary material, which is available to authorized users.

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A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study

Cited by 780 publications

References 29 publications

The threat of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-HvKP)

The threat of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-HvKP)

The role of myeloid-derived suppressor cells in chronic infectious diseases and the current methodology available for their study

Epidemiology of carbapenem-resistant Klebsiella pneumoniae bloodstream infections after renal transplantation from donation after cardiac death in a Chinese hospital: a case series analysis

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