Increasing Occurrence of Antimicrobial-Resistant Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae Isolates in China

Li, Wei; Sun, Guan; Yu, Yanhua; Li, Ning; Chen, Ming; Jin, Ronghua; Jiao, Yan‐Mei; Wu, Hao

doi:10.1093/cid/cit675

Cited by 236 publications

(262 citation statements)

References 37 publications

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“…The use of 48 hours as a cut-off for diagnosing nosocomial infections was arbitrary and could led to an overestimation of nosocomial infections. However, the frequency of community acquired hvKP infections in our patients was similar to that reported from other centers [26].…”

Section: Discussionsupporting

confidence: 91%

“…hvKP isolates comprised 7.5% of all KP isolates from our hospital, 60% of which were associated with infection. We identified hvKP more frequently in urine and abscess, and less frequently in blood, tracheal secretion, and bile than another similar large hospital in China [26]. Most community-acquired infections were blood infections or a presence of different abscess, similar to previous reports [12,16,27].…”

Section: Discussionsupporting

confidence: 87%

“…An exception to this finding was the presence of carbapenem resistance identified in hvKP isolated from tracheal secretions and urine of patients in Group 1 [12,26]. These two isolates were characterized as K2/ST25 and K2/ST65 with blaKPC-2, respectively.…”

Section: Discussionmentioning

confidence: 91%

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Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Xiao

Yao

Zhou

et al. 2017

J Infect Dev Ctries

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Introduction: Reports of hypermucoviscous Klebsiella pneumoniae (hvKP) isolated from fluids other than blood or abscess are rare. The aim of the study was to compare clinical and microbiological characteristics of hvKP found in blood or abscess fluid with those isolated from other loci. Methodology: A total of 24 non-repetitive hvKP isolates were collected from January 2013 to June 2014 from patients with hvKP infections. There were 15 in Group 1 (fluid other than blood or abscess) and 9 in Group 2 (blood or abscess fluid). Medical records of all patients were reviewed. Capsular polysaccharide (CPS) typing, virulence factor determination, and multilocus sequence typing (MLST) of hvKP isolates were performed. Results: Seventeen sequence types (STs) and 6 capsular serotypes were identified. Type K2 CC65 was most commonly identified in Group 1 and type K2 CC86 in Group 2. Deletion of pLVPK-derived loci were found in K2 and non-K1/K2 hvKP strains. Two virulent genes, fimH and ycfM, were identified more frequently in Group 2 than in Group 1. There was no difference in the frequency of other virulent genes or serotypes in the two groups. Two imipenem resistant hvKP isolates (cr-hvKP) were found in non-blood or abscess samples. Conclusions: hvKP isolated from different body fluids had similar clinical and microbiological characteristics. cr-hvKP identified in non-blood or abscess samples should raise our attention to the challenging situation and management of hvKP infection.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 87%

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Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Xiao

Yao

Zhou

et al. 2017

J Infect Dev Ctries

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“…Finally, although antibiotic resistance is a phenomenon associated primarily with classical K. pneumoniae, there have been reports of HV K. pneumoniae strains that carry ESBLs or carbapenemases (45,46). One recent study in China found ESBLs in 56% of classical K. pneumoniae strains compared to 17% of HV K. pneumoniae strains (47).…”

Section: Classical Antibiotic-resistant Emerging and Hypervirulentmentioning

confidence: 99%

“…For example, increased glucose concentrations result in the upregulation of capsule production though RmpA, while relatively high extracellular iron concentrations result in the downregulation of capsule production. In fact, 55 to 100% of HV K. pneumoniae strains express at least one copy of rmpA or rmpA2, compared to 7 to 20% of non-HV K. pneumoniae strains (47,214). These genes positively regulate the cps locus at the transcriptional level, resulting in the hypercapsule phenotype (202,(215)(216)(217).…”

Section: Capsulementioning

confidence: 99%

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Paczosa

Mecsas

2016

Microbiol Mol Biol Rev

1,357

1,345

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SUMMARYKlebsiella pneumoniaecauses a wide range of infections, including pneumonias, urinary tract infections, bacteremias, and liver abscesses. Historically,K. pneumoniaehas caused serious infection primarily in immunocompromised individuals, but the recent emergence and spread of hypervirulent strains have broadened the number of people susceptible to infections to include those who are healthy and immunosufficient. Furthermore,K. pneumoniaestrains have become increasingly resistant to antibiotics, rendering infection by these strains very challenging to treat. The emergence of hypervirulent and antibiotic-resistant strains has driven a number of recent studies. Work has described the worldwide spread of one drug-resistant strain and a host defense axis, interleukin-17 (IL-17), that is important for controlling infection. Four factors, capsule, lipopolysaccharide, fimbriae, and siderophores, have been well studied and are important for virulence in at least one infection model. Several other factors have been less well characterized but are also important in at least one infection model. However, there is a significant amount of heterogeneity inK. pneumoniaestrains, and not every factor plays the same critical role in all virulentKlebsiellastrains. Recent studies have identified additionalK. pneumoniaevirulence factors and led to more insights about factors important for the growth of this pathogen at a variety of tissue sites. Many of these genes encode proteins that function in metabolism and the regulation of transcription. However, much work is left to be done in characterizing these newly discovered factors, understanding how infections differ between healthy and immunocompromised patients, and identifying attractive bacterial or host targets for treating these infections.

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Increasing Occurrence of Antimicrobial-Resistant Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae Isolates in China

Abstract: HvKP strains are being isolated from patients in China with increasing frequency and constitute an increasing proportion of K. pneumoniae strains, indicating an increasing propensity for the acquisition of antimicrobial resistance.

Cited by 236 publications

References 37 publications

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Klebsiella pneumoniae: Going on the Offense with a Strong Defense

Fatal disseminated pyogenic infection due to hypermucoviscous hypervirulent Klebsiella pneumoniae: A case report and literature review

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