Tigecycline-non-susceptible hypervirulent Klebsiella pneumoniae strains in Taiwan

Cheng, Yi; Huang, Tzu Wen; Juan, Chih Han; Chou, Sheng Hua; Tseng, Yao Yi; Chen, Ting-Wen; Yang, Tsuey Ching; Lin, Yi Tsung

doi:10.1093/jac/dkz450

Cited by 26 publications

(15 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This could explain why the treatment was not effective in the case. Yi-Hsiang Cheng et al identified alterations in the rmpA as a mechanism of in-vivo tigecycline resistance development in a hvKP strain [16] . And Hiroki Namikawa et al reported that RFP, which inhibits not only transcription of the rmpA gene but also capsular polysaccharide biosynthesis to reduce capsular thickness, may serve as potential anti-virulence agent for hvKP infection.…”

Section: Discussionmentioning

confidence: 99%

Successful treatment of hypervirulent Klebsiella pneumoniae bacteremia with combination carbapenem and rifampicin

Lin

Cao

et al. 2021

IDCases

View full text Add to dashboard Cite

Hypervirulent Klebsiella pneumoniae (hvKP) with a high mucus phenotype, can cause liver abscess and extrahepatic invasive infection. The morbidity of hvKP infections has increased recently. Here we describe a case report of septicemia caused by hvKP due to the term septic arthritis of right knee joint in a 29-year-old male. The patient was persistent fever with a peak temperature at 40.6 °C. However, based on the drug sensitivity, the treatment failed frequently. The patient did not improve clinically on susceptible monotherapy antimicrobial. Combination therapy with meropenem and rifampicin (RFP) lead to clinical improvement and discharge.

show abstract

Section: Discussionmentioning

confidence: 99%

Successful treatment of hypervirulent Klebsiella pneumoniae bacteremia with combination carbapenem and rifampicin

Lin

Cao

et al. 2021

IDCases

View full text Add to dashboard Cite

show abstract

“…High-level expression of efflux pump is the main mechanism of bacterial resistance to tigecycline (45). Mutation in local transcriptional repressor acrR and global transcriptional activator ramA could result in the overexpression of AcrAB efflux pump (46).…”

Section: Discussionmentioning

confidence: 99%

Convergence of MCR-8.2 and chromosome-mediated resistance to colistin and tigecycline in an NDM-5-producing ST656 Klebsiella pneumoniae from a lung transplant patient

Zhao

Zhang

et al. 2021

Preprint

View full text Add to dashboard Cite

For infection caused by NDM-5-producing Klebsiella pneumoniae, tigecycline and colistin are the last treatment options. In this study, we characterized the first NDM-5 and MCR-8.2 co-harboring K. pneumoniae clinical isolate, combining with chromosomal gene-mediated resistance to colistin and tigecycline. The K. pneumoniae KP32558 was isolated from the bronchoalveolar lavage fluid from a lung transplant male patient. Whole genome sequencing was carried out using Illumina HiSeq sequencing platform as well as nanopore sequencing method. The K. pneumoniae KP32558 was identified as a pan-drug resistant bacteria, belonged to ST656, and harbored plasmid-encoded blaNDM-5 and mcr-8.2 genes. The blaNDM-5 gene was located on an IncX3 type plasmid, which was successfully transferred to Escherichia coli strain J53 without visible fitness cost. The mcr-8.2 gene was located on a conjugative plasmid pKP32558-2-mcr8. It had two replicons, IncFII(K) and IncQ1, harbored previously by another two mcr-8.2-carrying plasmids pMCR8_020135 and pMCR8_095845. These three plasmids were clustered into the same clade and derived from K. pneumoniae isolates of the same clonal complex, indicating that pKP32558-2-mcr8 may come from pMCR8_020135 and pMCR8_095845 related ancestor. The MIC of KP32558 for colistin was 256 mg/L, the 6 amino acid substitutions in the two-component system may involve in the high-level colistin resistance. The truncation in acrR gene, related to tigecycline resistance, was also identified. K. pneumoniae has evolved a variety of complex resistance mechanisms to the last-resort antimicrobials, close surveillance is urgently needed to monitor the prevalence of this clone.

show abstract

“…Tigecycline resistance genes included efflux pump-related genes ( acrA/B/R , oqxA/B/R , rarA , ramA/R , marA/R , soxS/R and lon ), tet genes [ tet (A), tet (X), tet (L) and tet (M)], and the ribosomal protein S10-encoding gene ( rpsJ ) [ 15 , 31 , 32 ], and colistin resistance genes were focused on LPS modification genes ( pmrA/B , phoP/Q , crrA/B , mgrB and mcr-1 ) [ 17 ]. By using CRKP-Urine1 as the reference sequence, tigecycline or colistin resistance genes were involved in the sequence analysis on the basis of the long contigs obtained by Illumina sequencing.…”

Section: Methodsmentioning

confidence: 99%

Resistance evolution of hypervirulent carbapenem-resistant Klebsiella pneumoniae ST11 during treatment with tigecycline and polymyxin

Jin

Chen

Shen

et al. 2021

Emerging Microbes & Infections

View full text Add to dashboard Cite

Hypervirulent carbapenem-resistant Klebsiella pneumoniae (hv-CRKP) has recently aroused increasing attention, especially ST11, the predominant CRKP clone in China.Here, we report a case of hv-CRKP-associated infection and reveal the in-host evolution of its mechanism of resistance to tigecycline and polymyxin under clinical therapy. A total of 11 K. pneumoniae carbapenemase (KPC)-producing CRKP strains were consecutively isolated from a male patient who suffered from continuous and multisite infections and successively received antibiotic treatment, including tigecycline and polymyxin. String and antimicrobial susceptibility tests identified seven hypermucoviscous strains and three tigecycline-resistant and four colistin-resistant strains. Galleria mellonella larvae infection model confirmed the hypervirulence. Pulsed-field gel electrophoresis (PFGE) separated three PFGE clusters among all strains, and further Southern blotting detected that blaKPC-2 was located on the same-sized plasmid. Whole-genome sequencing based on Illumina showed that all strains belonged to the hv-CRKP ST11-KL64 clone. Diverse hypervirulence factors and resistance genes were identified. Further sequencing with the Nanopore platform was performed on the CRKP-Urine1 strain, which contained one virulence plasmid (pVi-CRKP-Urine1) and two resistance plasmids (pKPC-CRKP-Urine1 and pqnrS1-CRKP-Urine1). The gene mutations responsible for tigecycline or colistin resistance were then amplified with PCR followed by sequencing, which indicated that mutations of ramR and lon were the potential loci for tigecycline resistance and that the pmrB, phoQ and mgrB genes for colistin resistance. A novel frameshift mutation of lon was identified in the high-level tigecycline-resistant strain (MIC, 128 mg/L). The results indicate that the hypervirulent ST11-KL64 clone is a potential threat to antiinfection treatment and is capable of rapid and diverse evolution of resistance during tigecycline and polymyxin treatment.

show abstract

Tigecycline-non-susceptible hypervirulent Klebsiella pneumoniae strains in Taiwan

Cited by 26 publications

References 34 publications

Successful treatment of hypervirulent Klebsiella pneumoniae bacteremia with combination carbapenem and rifampicin

Successful treatment of hypervirulent Klebsiella pneumoniae bacteremia with combination carbapenem and rifampicin

Convergence of MCR-8.2 and chromosome-mediated resistance to colistin and tigecycline in an NDM-5-producing ST656 Klebsiella pneumoniae from a lung transplant patient

Resistance evolution of hypervirulent carbapenem-resistant Klebsiella pneumoniae ST11 during treatment with tigecycline and polymyxin

Contact Info

Product

Resources

About