Clinical and Molecular Analysis of ST11-K47 Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae: A Strain Causing Liver Abscess

Abstract

Klebsiella pneumoniae has been the predominant pathogen of liver abscess, but ST11-K47 carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) has rarely been studied as the causative organism. We identified an ST11-K47 CR-hvKP (HvKp-su1) from the drainage fluid of a liver abscess in a Chinese man who was diagnosed with liver abscess combined with diabetes, pneumonia, pleural infection, abdominal abscess, and splenic abscess. HvKp-su1 was non-hypermucoviscous and lacked the magA and rmpA genes and pLVPK plasmid but exhibited high virulence, with a high mortality rate (90%) to wax moth larvae (G. mellonella), similar to the hypervirulent Klebsiella pneumoniae ATCC43816 (91.67%). Whole-genome sequencing and bioinformatics analysis indicated that HvKp-su1 possesses a plasmid similar to a type of pLVPK-like plasmid (JX-CR-hvKP-2-P2), which is an uncommon plasmid in CR-hvKP. HvKp-su1 carried multiple resistance genes, including blaKPC-2. blaTEM-1, blaSHV-55, and blaCTX-M-65; hypervirulence genes such as aerobactin (iutA), salmochelin (iroEN), and yersiniabactin (ybtAEPQSTUX); and the type 3 fimbriae-encoding system (mrkACDF). Moreover, v_5377 and v_5429 (cofT, CFA/III (CS8)) located on plasmid 1 were simultaneously predicted to be virulence genes. After the long-term combination use of antibiotics, the patient successfully recovered. In summary, our study clarified the clinical and molecular characteristics of a rare ST11-K47 CR-hvKP (HvKp-su1), raising great concerns about the emergence of ST11-K47 CR-hvKP with multidrug resistance and hypervirulence, and providing insights into the control and treatment of liver abscess caused by ST11-K47 CR-hvKP.

Genomic insights unveil the plasmid transfer mechanism and epidemiology of hypervirulent Klebsiella pneumoniae in Vietnam

“…similipneumoniae isolates (ST367 and ST816), all of which shared a common virulence plasmid. These findings raise significant concerns regarding the emergence and international spread of novel non-K1 and non-K2 hypervirulent Klebsiella strains, which may exhibit distinct propensities for acquiring antimicrobial resistance genes or differing capabilities in pathogenesis and transmission 39,40 . The heterogeneous makeup of surface structures, including K capsular types and O antigens, within the hvKp strains also presents a substantial challenge in the development of preventive measures, such as vaccines and innovative therapeutics, targeting these surface antigens.…”

ST11 Carbapenem-Resistant Klebsiella pneumoniae Clone Harboring blaNDM Replaced a blaKPC Clone in a Tertiary Hospital in China

“…The hypermucoviscous phenotype of hypervirulent K. pneumoniae (hvKP) is typically due to the increased production of capsular polysaccharides and specific virulence genes, such as rmpA and rmpA2 . The emergence of and rapid increase in hvKP strains in recent years, especially carbapenemase-producing hvKP-related infections in immunocompromised patients, are worrisome and pose a severe threat to patients [ 25 , 35 , 36 , 37 ].…”

Characterization of ST11 and ST15 Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae from Patients with Ventilator-Associated Pneumonia

“…For hyper and low virulence control, ATCC43816 and ATCC700603 were employed, respectively. 27 , 30 , 31 …”

“…For hyper and low virulence control, ATCC43816 and ATCC700603 were employed, respectively. 27,30,31 Galleria Mellonella Larvae Infection Assay Galleria mellonella larvae infection assay was performed to further assess bacterial pathogenicity. 20,[32][33][34] The isolates and controls were the same as those in the serum-killing assay.…”