Phenotypic and Genotypic Characterization of a Hypervirulent Carbapenem-Resistant Klebsiella pneumoniae ST17-KL38 Clinical Isolate Harboring the Carbapenemase IMP-4

Abstract

The combination of drug resistance and hypervirulence significantly limits the available treatment options for life-threatening infections caused by multidrug-resistant hvKP, especially CR-hvKP. To date, research on IMP-producing CR-hvKP is extremely scarce, and the virulence mechanisms of CR-hvKP are far more complicated and diverse than has been described in the literature so far.

Insights on the performance of phenotypic tests versus genotypic tests for the detection of carbapenemase-producing Gram-negative bacilli in resource-limited settings

“…These urges evaluating and regular updates on the sensitivity/specificity values of the existed phenotypic and genotypic diagnostic methods of the most common circulating CPGN pathogens. Although, the phenotypic detection and molecular characterization of CPGN pathogens had been previously reported in literature [13][14][15][16], still more studies are urgently required to validate the laboratory performance (sensitivity/specificity/positive predictive value/negative predictive value) of the respective phenotypic methods and to correlate them with the different types of carbapenemase enzymes [1,14]. Therefore, in this study we aimed to evaluate the performance of four major phenotypic approaches namely MHT, mCIM, BCT, combined disk test by EDTA (CDT) for detecting CPGN pathogens.…”

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

“…Furthermore, XH210 exhibited hypervirulence in the Galleria mellonella and mouse infection models but lacked the characteristic markers that are frequently associated with hypervirulence. The study demonstrated that hvKP strains without an obvious hypervirulence phenotype could evolve into CR-hvPK by acquiring the bla IMP-4 gene (He et al, 2022). The horizontal transmission of mobile genes is the key factor leading to the continuous evolution of KP into CR-hvKP (Chen et al, 2014).…”

“…In India, it was also reported that a hvKP strain harboring bla OXA and bla NDM genes encoding carbapenem resistance caused two deaths (Shankar et al, 2016). Notably, a study referenced a rare IMP-positive CR-hvKP isolate, XH210, recovered from human blood in Hangzhou, China (He et al, 2022). This CR-hvKP strain was characterized as having the ST17 KL38/O2 serotype and had the resistance plasmid pXH210-IMP, which carries the bla IMP-4 gene.…”

“…HvKP and CRKP can evolve into carbapenemresistant hypervirulent Klebsiella pneumoniae (CR-hvKP) by acquiring the plasmids carrying the carbapenem resistance gene or virulence-encoding gene, respectively. Notably, cKP can evolve into CR-hvKP by acquiring a hybrid plasmid carrying both the carbapenem resistance and hypervirulence genes (He et al, 2022). Therefore, CR-hvKP exhibits both hypervirulence and carbapenem resistance phenotypes, which may cause severe infections in individuals that are difficult to treat with current antibiotics, should attracted worldwide attention (Gu et al, 2018a).…”

Whole genome sequencing of OXA-232-producing wzi93-KL112-O1 carbapenem-resistant Klebsiella pneumoniae in human bloodstream infection co-harboring chromosomal ISEcp1-based blaCTX-M-15 and one rmpA2-associated virulence plasmid

“…Klebsiella pneumoniae is an important opportunistic pathogen associated with hospital- and community-acquired infections that has gained public attention due to its capability of acquiring resistance genes and plasmids ( Kong et al., 2021a ; Xu et al., 2021 ). Specifically, the emergence of carbapenem-resistant K. pneumoniae (CRKP) has limited effective therapies and poses a tremendous challenge in clinical settings ( He et al., 2022 ). It is well documented that K. pneumoniae usually is classified into classical K. pneumoniae (cKP) and hypervirulent K. pneumoniae (hvKP) based on different virulence levels ( Tian et al., 2021 ).…”