<p>High prevalence of KPC-2-producing hypervirulent&nbsp;<em>Klebsiella pneumoniae</em>&nbsp;causing meningitis in Eastern China</p>

Abstract

BackgroundKlebsiella pneumoniae has been the leading causative pathogen for adult bacterial meningitis in several Asian countries. The clinical and microbiological characteristics of K. pneumoniae meningitis in mainland China are still unknown.Materials and methodsThe clinical data of patients with K. pneumoniae meningitis from January 2011 to July 2017 in a tertiary hospital were retrospectively evaluated. The isolates were tested for antibiotic-resistance genes, virulence-associated genes, and molecular subtypes. Hyper-virulent K. pneumoniae (hvKP) was defined as the presence of pLVPK-like virulence plasmid.ResultsDuring the study period, a total of 48 patients with meningitis caused by K. pneumoniae were identified, accounting for 21.2% (48/226) of Gram-negative bacilli meningitis. Of the 44 available isolates, 65.9% (29/44) were carbapenem resistant, and all except one har-bored blaKPC-2. K64 was the most common serotype (n=13), followed by K47 (n=11) and K1 (n=5). The pLVPK-related genetic loci were found in about half of isolates (iutA: 56.8%, iucA: 56.8%, rmpA2:50.0%, rmpA: 43.2%, and iroN: 40.9%). Twenty-two strains carrying pLVPK-derived virulence plasmid were defined as hvKP. Notably, the coexistence of blaKPC-2-encoding plasmid and the pLVPK-derived virulence plasmid was detected in 15 strains (34.1%, 15/44), suggesting K. pneumoniae carbapenemase-2 (KPC-2)-producing hvKP. The proportion of KPC-2-producing hvKP by year increased remarkably from 0% (2011) to 71.4% (2017). Of the 15 KPC-2-producing hvKP strains, 80.0% (12/15) were assigned to sequence type 11 and 2 strains (13.3%) belonged to clonal complex 23. Most of the patients infected with KPC-2-producing hvKP had preceding postneurosurgical state (93.3%, 14/15) and severe pneumonia (73.3%, 11/15). All the cases (100%, 15/15) had fatal outcome.ConclusionThe high prevalence and mortality of K. pneumoniae, especially KPC-2-producing hvKP meningitis, in China should be of concern. The implementation of epidemiological surveillance and identification of an effective clinical treatment are paramount.

Uncovering the gut microbiota as a reservoir of ST11 hypervirulent KPC-2-producing Klebsiella pneumoniaeUncovering the gut microbiota as a reservoir of ST11 hypervirulent KPC-2-producing Klebsiella pneumoniae

“…Second, although we identified 19 fecal ST11-CR-HvKP colonization isolates, none of the colonized patients had ST11-CR-HvKP infections. A previous investigation described the high prevalence and mortality rate of ST11-CR-HvKP meningitis in our hospital [8], and K64 was also the most common serotype detected in this study. Future investigations addressing the transition from ST11-CR-HvKP carriage to infection in high-risk patients will be of great significance.…”

“…The identification of this ST11-CR-HvKP strain demonstrated that carbapenem resistance and virulence had converged in an epidemic clone that could become a serious public health issue [5]. Subsequently, cases of ST11-CR-HvKP infection have been documented in diverse regions in China [6][7][8]. These reports suggest that this clone is widely spread in China; however, the underlying mechanism that enables its wide dissemination remains unclear.…”

<p>Dynamic Epidemiology and Virulence Characteristics of Carbapenem-Resistant <em>Klebsiella pneumoniae</em> in Wenzhou, China from 2003 to 2016</p>

“…24 The emergence of hypervirulent lineages carrying antimicrobial resistance genes including carbapenemases is now being increasingly reported: with limited treatment measures and high mortality, they are considered a "super-bug". [18][19][20][21] With reports of hypervirulent CRKP increasing rapidly in China, [25][26][27][28][29] we sought to deep dive into the details of this emergence using microbiological characterization and patient metadata acquired in a single large hospital in Wenzhou, China from 2003 to 2016. In this study, we identified the resistance mechanism and virulence characteristics of 214 isolates of CRKP from amongst 2299 total isolates of K. pneumoniae associated with infection, and the proportion of isolated CRKP was increasing and reaches up to 20% in the final year of the study (2016).…”

Epidemiology and clinical significance of pLVPK-like virulence plasmid in KPC-2-producing Klebsiella pneumoniae infections in eastern China: a preliminary exploration

“…Here, we showed that previous neurosurgery within 4 weeks could help clinicians to identify patients of high risk to acquire pVir + -KPC-kp infections (p = 0.002). Our previous study reported that about half of K. pneumoniae meningitis was caused by pVir + -KPC-kp in our hospital from 2011 to 2017 [27]. In order to establish the correlation of neurosurgery and meningitis, we performed subgroup analysis of post-neurosurgery patients.…”