Epidemiological characteristics and molecular evolution mechanisms of carbapenem-resistant hypervirulent Klebsiella pneumoniae

Abstract

Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP), a type of Klebsiella pneumoniae (KP) that exhibits hypervirulence and carbapenem resistance phenotypes, can cause severe infections, both hospital- and community-acquired infections. CR-hvKP has brought great challenges to global public health and is associated with significant morbidity and mortality. There are many mechanisms responsible for the evolution of the hypervirulence and carbapenem resistance phenotypes, such as the horizontal transfer of the plasmid carrying the carbapenem resistance gene to hypervirulent Klebsiella pneumoniae (hvKP) or carbapenemase-producing Klebsiella pneumoniae (CRKP) acquiring a hypervirulence plasmid carrying a virulence-encoding gene. Notably, KP can evolve into CR-hvKP by acquiring a hybrid plasmid carrying both the carbapenem resistance and hypervirulence genes. In this review, we summarize the evolutionary mechanisms of resistance and plasmid-borne virulence as well as the prevalence of CR-hvKP.

Carbapenem-resistant hypermucoviscous Klebsiella pneumoniae clinical isolates from a tertiary hospital in China: Antimicrobial susceptibility, resistance phenotype, epidemiological characteristics, microbial virulence, and risk factors

“…SPs can acquire iron from the binding protein in the host body and can then bind to the receptor to re-enter cells. Four SPs secreted by hvKP, namely salmochelin, enterobactin, yersiniabactin, and aerobactin, have been reported previously ( Chen et al., 2018 ; Han et al., 2022 ). The function of aerobactin gene iutA is well-correlated with the ex vivo growth/survival of hvKP in humans ( Russo et al., 2015 ).…”

“…Most of the carbapenem-resistant HMKP isolates were associated with significant risk factors such as prior antibiotic therapy, previous hospitalization for 5 days or more, invasive procedures, and mechanical ventilation. Other studies have reported that prolonged hospitalization, invasive procedures (e.g., central or urinary catheter insertion, tracheostomy, and invasive abdominal procedures), serious underlying diseases (e.g., diabetes mellitus, hemiplegia, and solid tumors), and prior carbapenem exposure, were independent predictors for infection development in patients with carbapenem-resistant HMKP isolates ( Borer et al., 2012 ; Chen et al., 2018 ; Han et al., 2022 ).…”

“…The function of aerobactin gene iutA is well-correlated with the ex vivo growth/survival of hvKP in humans ( Russo et al., 2015 ). Hence, SP-related encoding genes, especially iutA , are key markers in the identification of hvKP ( Russo et al., 2015 ; Han et al., 2022 ). Many virulence-based experiments may be required for isolates from hvKP in vitro and in vivo , such as in mice models, greater wax moth ( G. mellonella ) models, and neutrophil phagocytosis assays.…”

High-Molecular-Weight Plasmids Carrying Carbapenemase Genes blaNDM-1, blaKPC-2, and blaOXA-48 Coexisting in Clinical Klebsiella pneumoniae Strains of ST39

“…This hybrid plasmid has a large size (~326 Kb) and was formed as a result of an unknown event of recombination. In recent years, many studies have reported carbapenem-resistant hypervirulent K. pneumoniae (CR-hvKP) [ 23 , 24 ].…”

“…In recent years, many studies have reported the evolution of K. pneumoniae into carbapenem-resistant hypervirulent K. pneumoniae (CR-hvKP) via the acquisition of hybrid plasmids. Many variants of Vir-KPC plasmids have been described to date in different regions [ 23 ]. Emergence of hybrid resistance and virulence plasmids harboring ND metallo-beta-lactamase in K. pneumoniae of different STs (ST15, ST147, ST395, and ST874) has been reported in Russia [ 24 ].…”