Community-acquired infection caused by the uncommon hypervirulent Klebsiella pneumoniae ST66-K2 lineage

Abstract

Klebsiella pneumoniae (Kp) reference strain Kp52.145 is widely used in experimental Klebsiella pathophysiology. Since 1935, only one other strain of the same sublineage (sequence type ST66, capsular serotype K2) was isolated (AJ210, Australia). Here, we describe a community-acquired invasive infection caused by a ST66-K2 Kp strain in France. Four hypermucoviscous Kp isolates responsible for acute otitis media, meningitis, bacteraemia and bacteriuria, respectively, were obtained from a patient with a history of chronic alcoholism and diabetes mellitus, and infected with HIV. The isolates were characterized by phenotypic and genomic methods. The four genetically identical ST66-K2 isolates presented a full antimicrobial susceptibility profile, including to ampicillin, corresponding to a single strain (SB5881), which was more closely related to AJ210 (135 SNPs) than to Kp52.145 (388 SNPs). Colibactin and yersiniabactin gene clusters were present on the integrative and conjugative element ICEKp10 in the chromosome. The two plasmids from Kp52.145 were detected in SB5881. In addition to carrying genes for virulence factors RmpA, aerobactin and salmochelin, plasmid II has acquired in SB5881, the conjugation machinery gene cluster from plasmid I. We report the first case of community-acquired infection caused by a hypervirulent ST66-K2 Kp strain in Europe. This demonstrates the long-term persistence of the high-virulence and laboratory model ST66-K2 sublineage. The combination of a conjugative apparatus and major virulence genes on a single plasmid may contribute to the co-occurrence of hypervirulence and multidrug resistance in single Kp strains.

Isolation and Characterization of a Novel Lytic Bacteriophage against the K2 Capsule-Expressing Hypervirulent Klebsiella pneumoniae Strain 52145, and Identification of Its Functional Depolymerase

“…The target microorganism in our study was the hypervirulent Klebsiella pneumoniae strain, 52145 [ 51 ], a reference strain of serotype O1:K2 that has been thoroughly analyzed since its first isolation [ 2 , 56 , 57 ]. This strain belonged to the ST66-K2 lineage [ 17 ], which was recently reported to cause community-acquired infections [ 58 ].…”

Antibiotic Sensitivity Screening of Klebsiella spp. and Raoultella spp. Isolated from Marine Bivalve Molluscs Reveal Presence of CTX-M-Producing K. pneumoniae

“…Interestingly, no chromosomal bla SHV was detected in the chromosome (CP052386.1) of K. pneumoniae strain C17KP0055 from South-Korea, which is highly similar to the strain in our study. This is rare but absence of SHV has previously been reported in some K. pneumoniae strains [49,50].…”

Hypervirulent Klebsiella pneumoniae of Lineage ST66-K2 Caused Tonsillopharyngitis in a German Patient

“…Rodrigues et al recently described the first ST66-K2 isolate identified in Europe; this isolate was obtained from blood and urine samples of a patient infected with HIV in 2018 in France [ 11 ]. Phylogenetic analysis revealed a relationship to the three known ST66-K2 isolates: (I) SB5881 isolated in 2018 from France [ 11 ], (II) AJ210 isolated in 2010 from Australia [ 18 ], and (III) “ancestral” reference Kp52.145 detected in 1935 in Indonesia ( Figure 2 ) [ 11 , 19 ]. However, 18-0005 was more closely related to SB5881 (84 SNPs) than to AJ210 (152 SNPs) or Kp52.145 (409 SNPs).…”

“…While the majority of serotype K1 isolates belong to CG23, serotype K2 isolates are genetically more diverse [ 9 ]. The first completely sequenced hvKp strains were NTUH-K2044 (CG23, serotype K1) and Kp52.145 (CG66, serotype K2); both have been used as reference isolates for comparative studies [ 10 , 11 ]. However, clinical isolates of the lineage CG66-K2 (related to Kp52.145) have only been documented twice worldwide [ 11 ].…”

“…The first completely sequenced hvKp strains were NTUH-K2044 (CG23, serotype K1) and Kp52.145 (CG66, serotype K2); both have been used as reference isolates for comparative studies [ 10 , 11 ]. However, clinical isolates of the lineage CG66-K2 (related to Kp52.145) have only been documented twice worldwide [ 11 ]. Here we describe a community-acquired infection by a hvKp CG66-K2 isolate from a German patient.…”