Emergence of a Fatal ST11-KL64 Tigecycline-Resistant Hypervirulent Klebsiella pneumoniae Clone Cocarrying bla _NDM and bla _KPC in Plasmids

Abstract

Infections with CRKP coproducing KPC and NDM currently have limited clinical antibacterial options, and tigecycline is used as the last line of defense for therapy. However, this study found that CR-hvKP infection with tigecycline resistance, which may lead to many bacteria being resistant to most commonly used antibiotics, brought significant challenges to clinical treatment. The clonal propagation of ST11-KL64 CRKP should receive sufficient attention.

Clinical and Molecular Characteristics of Patients with Bloodstream Infections Caused by KPC and NDM Co-Producing Carbapenem-Resistant Klebsiella pneumoniae

“…In 2021, Huang et al reported that a KPC-2-producing K. pneumoniae strain acquired a bla NDM-5 -harbouring plasmid during ceftazidime/avibactam treatment. 29 The emergence of CRKP coharboring bla KPC-3 and bla NDM-1 , 30 CRKP coharboring bla KPC-2 and bla NDM-6 , 31 hypervirulent CRKP coharboring bla KPC-2 and bla NDM-1 , 32 tigecycline-resistant hypervirulent K. pneumoniae cocarrying bla KPC-2 and bla NDM-5 , 33 polymyxin B-resistant hypervirulent K. pneumoniae coharboring bla KPC-2 and bla NDM-1 , 34 and CRKP coharboring bla KPC-2 , bla NDM-1 , and tmexCD1-toprJ1 have been successively reported. 35 …”

Dissemination and characteristics of carbapenem-resistant Klebsiella pneumoniae in nine district hospitals in southwestern China

“…Capsular serotyping and serum killing assay showed that the ST11 HV-CRKP strains were K-nontypeable and showed high serum resistance, which also carried both rmpA and aerobactin virulent genes ( Yao et al, 2015 ). HV-CRKP ST11 strain has been confirmed to lead to increased mortality in hospitalized patients, prolonged hospitalization, and nosocomial transmission, which substantially threatened human health and needed great attention ( Gu et al, 2018 ; Huang J. et al, 2022 ; Huang N. et al, 2022 ). Interestingly, we isolated two HV-CRKP strains of ST592 for the first time.…”

Coexistence of tmexCD3-toprJ1b tigecycline resistance genes with two novel blaVIM-2-carrying and blaOXA-10-carrying transposons in a Pseudomononas asiatica plasmid

“…The Resistance-Nodulation-Division (RND) MDR efflux pump gene cluster tmexCD1-toprJ1 or the variants such as the tnfxB3-tmexC3.2-tmexD3b-toprJ1b is one of the mechanisms which mediates the tigecycline resistance. Additionally, metallo-b-lactamases (MBLs) and carbapenemase coding genes like bla KPC are the main mechanisms mediating carbapenem resistance (Hu et al, 2021;Huang et al, 2022). Emergence of tigecycline and carbapenem resistant bacteria such as E. coli, Klebsiella spp.…”