Epidemiological characteristics an outbreak of ST11 multidrug-resistant and hypervirulent Klebsiella pneumoniae in Anhui, China

Abstract

Klebsiella pneumoniae has become a primary threat to global health because of its virulence and resistance. In 2015, China reported multidrug-resistant (MDR) and hypervirulent K. pneumoniae (hvKp) isolates. The emergence of MDR-hvKp poses a significant threat to public health. We collected 76 MDR K. pneumoniae isolates from the same hospital, of which there were a total of six MDR-hvKp isolates. We performed multilocus sequence typing (MLST) and capsular typing, whole genome sequencing, comparative genome analysis, and phylogenetic analysis as well as phenotypic experiments, including growth curves, mucoviscosity assay, Galleria mellonella infection model, human whole blood survival, and human neutrophil bactericidal assay to further characterize the samples. We identified six large plasmids carrying extended spectrum β-lactamase (ESBL) genes or carbapenemase genes (blaCTX–M–65, blaKPC–2, blaSHV–12, blaSHV–158), 9 plasmids containing other drug resistance genes, and 7 hypervirulence plasmids carrying rmpA and rmpA2 in ST11 MDR-hvKp isolates. Some of these plasmids were identical, whereas others differed only by insertion elements. In addition, we identified a plasmid, p21080534_1, that carries hypervirulence genes (iucABCD, iutA, rmpA2), a carbapenemase gene (blaKPC–2), and an ESBL gene (blaSHV–12), as well as MDR-hvKp 21072329, which did not carry rmpA or rmpA2, but exhibited hypervirulence and hypermucoviscosity. ST11 MDR-hvKp derived from hypervirulence and multidrug resistance plasmids not only causes significant treatment difficulties, but also represents an unprecedented challenge to public health. Therefore, urgent measures are needed to limit further spread.

Prevalence of multidrug-resistant hypervirulent Klebsiella pneumoniae without defined hypervirulent biomarkers in Anhui, China: a new dimension of hypervirulence

“…Similarly, to detect SNPs in 22091569, it was compared with ST307 isolates ( He et al, 2022 ). Here, we identified 17 mutations were same in each ST307 isolates.…”

“…Antibiotic susceptibility of all clinical isolates was determined by previously described methods with slight modifications ( He et al, 2022 ). The MICs of routinely used antibiotics ( Supplementary Table S2 ), were determined by the VITEK 2 Compact System and the results of the antimicrobial susceptibility tests were interpreted according to the Clinical Laboratory Standards Institute ( CLSI, 2022 ).…”

“…Because carbapenem-resistant hvKp strains may cause severe, untreatable infections in healthy individuals ( Lee et al, 2017 ). Recently, carbapenem-resistant ST11 and ST15 hvKp have been reported from China, which caused an outbreak in the provincial hospital ( He et al, 2022 ; Zhao et al, 2022 ). There have also been reports of MDR-hvKps in other parts of Asia and worldwide ( Tang et al, 2020 ; Wyres et al, 2020 ; Tian et al, 2022 ).…”

Molecular characteristics and antimicrobial resistance profiles of Carbapenem-Resistant Klebsiella pneumoniae isolates at a tertiary hospital in Nanning, China

“…ST11 is a single-locus variant (tonB) of ST258, and both them belong to the clone complex CC258 [ 15 ]. ST258 is prevalent in the United States and several European countries[ 34 ], while ST11 is the most common type in Asia, and accounts for up to 60% of CRKP in China [ 35 , 36 ]. In addition, we found that NDM-1-producing CRKP ST17 isolates had an outbreak in our hospital, and the isolates mainly came from neonatology department.…”

Geographical distribution, disease association and diversity ofKlebsiella pneumoniaeKL and O antigens in India: roadmap for vaccine development

“…[8]; [9]; [10]; [11]. MDR hypervirulent K. pneumoniae (hvKp) strains have been emerging, spawning a new generation of hypervirulent "superbugs" [12]. Newer therapeutics, such as vaccines or monoclonal antibodies, are needed to combat MDR K. pneumoniae.…”