An outbreak of extensively drug-resistant and hypervirulent Klebsiella pneumoniae in an intensive care unit of a teaching hospital in Southwest China

Liu, Siyi; Ding, Yinhuan; Xu, Yujie; Li, Zhaoyinqian; Zeng, Zhangrui; Wang, Zhibin

doi:10.3389/fcimb.2022.979219

Cited by 6 publications

(6 citation statements)

References 56 publications

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“…[184][185][186][187][188] If no major action is taken, Africa could experience outbreaks of hypervirulent CRBs, as is currently the case in Asia. 10,11,[189][190][191] Like in this review, Ahlstrom et al 192 reported hypervirulent CR K. pneumoniae isolates from wild birds in Spain and Ukraine.…”

Section: Discussionmentioning

confidence: 68%

Carbapenem Resistance in Animal-Environment-Food from Africa: A Systematic Review, Recommendations and Perspectives

Dossouvi,

Ametepe

2024

IDR

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Background The World Health Organization (WHO) has classified carbapenem-resistant Enterobacteriaceae, Pseudomonas aeruginosa ( P. aeruginosa ), and Acinetobacter baumannii ( A. baumannii ) as high-priority pathogens, and carbapenem-resistant bacteria (CRB) have been reported to spread between humans, animals, and the environment. Objective This study aimed to conduct a systematic review of carbapenem resistance in animals, foods, and the environment on the African continent and to provide recommendations and perspectives for better prevention and control of carbapenem resistance in Africa. Results A total of 137 research articles collected from 2009 to 2023 were selected for this review, including articles reporting carbapenem-resistant bacteria in animals (81/137; 59.1%), the environment (66/137; 48.2%), and foods (26/137; 19%). Carbapenem-resistant bacterial species belonged to 31 genera and 17 families, including mainly Escherichia spp. (68/127; 53.5%); Klebsiella spp. (45/127; 35.4%); Pseudomonas spp. (20/127; 15.7%), Enterobacter spp. (19/127; 15%) and Acinetobacter spp. (15/127; 11.8%). The prevalence of CRBs by country ranged from 1.1% to 48.5%, and the pooled prevalence of CRBs isolated from animal-environment-food in Africa was 19.1% (2804/14,684; Standard Deviation = 15). Twenty carbapenemase families belonging to A, B, C, and D Ambler classes were reported, including mainly carbapenemase genes from bla OXA (44/84; 52.4%), bla NDM (34/84; 40.5%), bla SHV (23/84; 27.4%), bla KPC (22/84; 26.2%), bla VIM (19/84; 22.6%), and bla IMP (12/84; 14.3%) families. The reported mobile genetic elements (MGE) carrying carbapenemase-encoding genes included plasmids (16/19; 84.2%), integrons (3/19; 15.8%), transposons (3/19; 15.8%), and insertion sequences (2/19; 10.5%). bla OXA-48 was often carried by (60kb-65kb) IncL/M-type pOXA-48 plasmids, while bla NDM-5 was often carried by (45–50kb) IncX-type plasmids. Moreover, 25 articles investigated and reported virulent and hypervirulent CRBs that carried multiple virulence factors. Conclusion Animal-environment-food ecosystems would constitute reservoirs of CRBs involved in human infections. The One Health approach and constant collaboration between governments are necessary to drastically reduce the mortality rates linked to antimicrobial resistance.

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Section: Discussionmentioning

confidence: 68%

Carbapenem Resistance in Animal-Environment-Food from Africa: A Systematic Review, Recommendations and Perspectives

Dossouvi,

Ametepe

2024

IDR

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“…We investigated 11 virulence-associated and nine drug resistance-associated genes and found that the positive rates of rmpA , rmpA2 , aerobactin, iroB , wcaG , alls , and Kfu were relatively higher for T6SS-positive isolates than for T6SS-negative isolates ( p < 0.001). These seven virulence factors are associated with high pathogenicity: rmpA and rmpA2 are involved in the hypermucoviscosity phenotype and capsular polysaccharide synthesis; aerobactin and iroB are siderophores, and aerobactin plays a critical role in hvKp virulence; and wcaG regulates fucose biosynthesis and enhances the ability of K. pneumoniae to resist neutrophil phagocytosis ( Zheng et al, 2018 ; Russo and Gulick, 2019 ; Liu et al, 2022 ; Xu et al, 2022 ). These results further indicate that the T6SS-positive isolates were hypervirulent; however, the specific virulence mechanism involved in this process requires further study.…”

Section: Discussionmentioning

confidence: 99%

Molecular epidemiology and clinical characteristics of the type VI secretion system in Klebsiella pneumoniae causing abscesses

et al. 2023

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PurposeThe type VI system (T6SS) has the potential to be a new virulence factor for hypervirulent Klebsiella pneumoniae (hvKp) strains. This study aimed to characterize the molecular and clinical features of T6SS-positive and T6SS-negative K. pneumoniae isolates that cause abscesses.Patients and methodsA total of 169 non-duplicate K. pneumoniae strains were isolated from patients with abscesses in a tertiary hospital in China from January 2018 to June 2022, and clinical data were collected. For all isolates, capsular serotypes, T6SS genes, virulence, and drug resistance genes, antimicrobial susceptibility testing, and biofilm formation assays were assessed. Multilocus sequence typing was used to analyze the genotypes of hvKp. T6SS-positive hvKp, T6SS-negative hvKp, T6SS-positive cKP, and T6SS-negative cKP (n = 4 strains for each group) were chosen for the in vivo Galleria mellonella infection model and in vitro competition experiments to further explore the microbiological characteristics of T6SS-positive K. pneumoniae isolates.ResultsThe positive detection rate for T6SS was 36.1%. The rates of hvKp, seven virulence genes, K1 capsular serotype, and ST23 in T6SS-positive strains were all higher than those in T6SS-negative strains (p < 0.05). Multivariate logistic regression analysis indicated that the carriage of aerobactin (OR 0.01) and wcaG (OR 33.53) were independent risk factors for T6SS-positive strains (p < 0.05). The T6SS-positive strains had a stronger biofilm-forming ability than T6SS-negative strains (p < 0.05). The T6SS-positive and T6SS-negative strains showed no significant differences in competitive ability (p = 0.06). In the in vivo G. mellonella infection model, the T6SS(+)/hvKP group had the worst prognosis. Except for cefazolin and tegacyclin, T6SS-positive isolates displayed a lower rate of antimicrobial resistance to other drugs (p < 0.05). The T6SS-positive isolates were more likely to be acquired from community infections (p < 0.05).ConclusionKlebsiella pneumoniae isolates causing abscesses have a high prevalence of T6SS genes. T6SS-positive K. pneumoniae isolates are associated with virulence, and the T6SS genes may be involved in the hvKp virulence mechanism.

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“…The PFGE assay has been considered as a reference method for homology investigation of clinical infectious disease strains, especially in hospital outbreaks [25]. Compared to PFGE, MLST is more convenient to operate but less accurate.…”

Section: Discussionmentioning

confidence: 99%

MgrB mutations causing colistin resistance in ST11 and ST15 Klebsiella pneumoniaes in a tertiary teaching hospital in China

zhao

Song

Guo

et al. 2022

Preprint

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Introduction:Colistin-resistant carbapenem-resistant Klebsiella pneumoniae (ColR-CRKP) is a threat to public health safety. The main cause of polymyxin resistance is a change in the negative charge and L-Ara-N and PEtN molecules on the cell membrane, which leads to a decrease in the affinity of polymyxin for the strain. Methodology: In this study, (ColR-CRKP) isolates and clinical data were collected from a tertiary teaching hospital in China .Testing of antimicrobial susceptibility explained on the European Committee on Antimicrobial Susceptibility Testing criteria (EUCAST), Mutations and expression of drug-resistant genes were detected by PCR and RT-PCR. Genotyping of isolates analysised by MLST and PFGE. Results:Fourteen ColR-CRKP strains were collected and all isolates were resistant to colistin and most other clinical antibiotics (except tigecycline and cotrimoxazole), and were divided into 6 different PFGE clusters, and most strains clustered in B,C,D groups. Base mutations in the mgrB gene that can lead to changes in amino acid sequence were found in all 14 strains. Missense mutations a55→t translated into S32C were found in 85.7% isolates (n=12; KP1-9, KP11-12 and KP14). The expression level of mgrB gene was decreased in all ColR-CRKP strains. Conclusions:Third-generation cephalosporins and enzyme inhibitors, as well as carbapenems, may be causative for the mutation. The new challenge for the treatment of ColR-CRKP requires broader attention.Our study showed that mutations in the mgrB gene can lead to the development of polymyxin resistance in in ST11 and ST15-KPC-2-producing K. pneumoniae in this region.

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An outbreak of extensively drug-resistant and hypervirulent Klebsiella pneumoniae in an intensive care unit of a teaching hospital in Southwest China

Cited by 6 publications

References 56 publications

Carbapenem Resistance in Animal-Environment-Food from Africa: A Systematic Review, Recommendations and Perspectives

Carbapenem Resistance in Animal-Environment-Food from Africa: A Systematic Review, Recommendations and Perspectives

Molecular epidemiology and clinical characteristics of the type VI secretion system in Klebsiella pneumoniae causing abscesses

MgrB mutations causing colistin resistance in ST11 and ST15 Klebsiella pneumoniaes in a tertiary teaching hospital in China

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