Co-occurrence of three different plasmids in an extensively drug-resistant hypervirulent Klebsiella pneumoniae isolate causing urinary tract infection

Zhu, Xiaokui; Sun, Chuanyu; Chen, Hongyin; Zhan, X.J.; Liu, Chenxin; Liu, Xin; Yue, Changwu; Hong, Samuel L.; Lu, Haojie; Xu, Jin

doi:10.1016/j.jgar.2020.09.002

Cited by 13 publications

(10 citation statements)

References 35 publications

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“…The infection rate has exceeded 9%. All areas are severely infected, among which the intensive care unit, respiratory department, urology department, and pediatrics have become the high-risk areas of infection, and the drug resistance is serious [ 4 ]. Many major hospitals have found many cases of infections caused by carbapenem-resistant Klebsiella pneumoniae (CR-KP) and even pan-resistant Klebsiella pneumoniae .…”

Section: Introductionmentioning

confidence: 99%

Analysis of Carbapenemase-Resistant Genotypes of Highly Virulent Klebsiella pneumoniae and Clinical Infection Characteristics of Different MLST Types

Liu

Wang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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Carbapenemase-resistant Klebsiella pneumoniae (CR-KP) has become one of the nosocomial infections that seriously threaten the lives of patients, greatly increasing the burden on patients. In order to explore the resistance mechanism of clinically isolated CR-KP to carbapenems and perform multilocus sequence typing (MLST), to study the clinical characteristics of patients with different ST types of infection, we collected 74 CR-KP strains clinically isolated from the main 6 hospitals in Zhejiang province from January 2018 to July 2020. The sensitivity of the tested strains to 23 antibacterial drugs was determined by the microbroth dilution method, and PCR was applied. Gene amplification technology and DNA sequencing methods were used to detect the carbapenemase gene of the tested strains. Through the MLST of the tested strains, the clonal correlation and molecular epidemiological characteristics of the tested strains were explored, and the characteristics of CR-KP resistance, resistance mechanisms, and clinical characteristics of bacterial infections under different MLST types were analyzed at the same time. The results showed that 74 carbapenem-resistant Klebsiella pneumoniae strains showed high resistance to 21 commonly used antibacterial drugs, and all carbapenemase phenotypic screening tests were positive. MLST typing showed that 74 CR-KP strains had 17 ST typings, and ST11 was the dominant type (54.05%). The study also found that these ST11 strains are more likely to be resistant to carbapenem antibiotics. Most of them produce KPC carbapenemase, and a few are IMP, VIM, and NDM. Univariate analysis suggested that the proportion of patients in the ST11 group receiving treatment in ICU, the use rate of mechanical ventilation, and the proportion of drainage tube indwelling were higher than those in the non-ST11 group, and the survival rate of the ST11 group was lower than that of the non-ST11 group. Clinical data suggested that the same hospital was dominated by the same clonal epidemic in the same period. In view of the analysis of clinical data suggesting that patients who have received ICU treatment, mechanical ventilation, and drainage tube indwelling are prone to the risk of CR-KP strain (especially ST11) infection and low survival rate, such patients should arouse extensive clinical attention.

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Section: Introductionmentioning

confidence: 99%

Analysis of Carbapenemase-Resistant Genotypes of Highly Virulent Klebsiella pneumoniae and Clinical Infection Characteristics of Different MLST Types

Liu

Wang

et al. 2021

Evidence-Based Complementary and Alternative Medicine

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“…Different from the previous clinical reports of a single variant, multiple different variants of a single bla KPC-2 -positive strain were found in two patients this time, including mutations at different loci over the same period and successive variations to strengthen the resistance ( 32 ). A total of five kinds of bla KPC alleles, including bla KPC-33 , bla KPC-35 , bla KPC-76 , bla KPC-78 , and bla KPC-79 , were detected on IncFII/IncR-type plasmids that were also reported in bla KPC-2 -positive strains from Shanghai and neighboring cities ( 33 , 34 ). Such mutations firstly appeared after 9 to 18 days of medication and further evolved after another 30 days this time, which were typically reported to occur after 10 to 19 days, sometimes up to 33 days ( 31 , 35 ).…”

Section: Discussionmentioning

confidence: 91%

Multiple Novel Ceftazidime-Avibactam-Resistant Variants of bla _KPC-2 -Positive Klebsiella pneumoniae in Two Patients

et al. 2022

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Carbapenem-resistant K. pneumoniae which was classified as the most urgent threat by World Health Organization, is the most critical public health concern due to its high mortality rate. Recently, the rapid mutation of bla KPC has occurred during anti-infective therapy, which posed an unexpected challenge for both the diagnostic laboratory and clinical practice.

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“…The hypervirulence combined with drug-resistant strains is associated with increasing emergence of such strains and poses a major challenge to clinical anti-infective therapy ( Lee et al., 2017 ; Mataseje et al., 2019 ; Zhu et al., 2020 ; Zhang et al., 2021 ). In this study, the detection rate of CRE in hvKP was higher than it was in cKP; this could be attributed to bla KPC-2 , which was identified to be successfully transferred into EC600 by conjugation test, indicating that this hypervirulent strain could acquire resistance genes by horizontal gene transfer (HGT) ( Lan et al., 2021 ).…”

Section: Discussionmentioning

confidence: 99%

“…Notably, hvKP can cause infection at multiple locations: endophthalmitis, abdominal disease, thoracic disease, central nervous system disease, and genitourinary tract infections ( Russo and Marr, 2019 ). In recent times, its multidrug-resistant and extensively drug-resistant isolates have also been detected in UTIs ( Mataseje et al., 2019 ; Zafar et al., 2019 ; Zhu et al., 2020 ). The finding that hvKP infection is more likely to cause serious consequences and bacteremia than classical K. pneumoniae (cKP) as a causative agent of UTIs is particularly concerning ( Kim et al., 2017 ).…”

Section: Introductionmentioning

confidence: 99%

Molecular and clinical characterization of hypervirulent Klebsiella pneumoniae isolates from individuals with urinary tract infections

Tang²,

Liu³

et al. 2022

Front. Cell. Infect. Microbiol.

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Despite being a significant public health concern, hypervirulent Klebsiella pneumoniae (hvKP) has rarely been investigated in urinary tract infections (UTIs). To investigate the molecular and clinical characterization of hvKP in UTIs, we collected K. pneumoniae strains and clinical data from patients with UTIs. HvKP was confirmed by virulence-related genes and the Galleria mellonella model and sequenced by next-generation sequencing. Our data showed that 30/121 isolates were hvKP [17 carbapenem-resistant hypervirulent K. pneumoniae (CR-hvKP), 12 hvKP, and 1 extended-spectrum β-lactamase-producing hvKP]; these had higher resistance to most antimicrobials and were more likely to cause complicated UTIs (cUTIs). Notably, the mucoid phenotype-regulating genes prmpA and prmpA2 were truncated in 3 and 19 hvKP, respectively. Eight serotypes were detected and divided into three groups: K64 (n = 17), K1/K2 (n = 6), and others (n = 7). Furthermore, 16/17 K64 hvKP isolates were CR-hvKP but with a lower mortality rate of G. mellonella as the truncated prmpA/prmpA2 incurred high fitness cost to the isolates. In addition, all K64 isolates belonged to ST11 with the same cluster, and in two of these strains (KP88 and KP92) blaKPC-2 gene was successfully transferred to EC600. Genetic environment analysis showed that IS26–tnpR–ISKpn27–blaKPC−2–ISKpn6 may be the core structure in the horizontal transfer of blaKPC-2. The highest mortality rate among the infected G. mellonella was observed in the K1/K2 group. In conclusion, hvKP had a higher resistance rate and was more likely to lead to cUTIs. Convergence of hypervirulence and carbapenem resistance in a transmissible ST11 clone of K64 K. pneumoniae was mediated by a plasmid in UTIs. Therefore, surveillance of hvKP in UTIs should be strengthened.

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Co-occurrence of three different plasmids in an extensively drug-resistant hypervirulent Klebsiella pneumoniae isolate causing urinary tract infection

Cited by 13 publications

References 35 publications

Analysis of Carbapenemase-Resistant Genotypes of Highly Virulent Klebsiella pneumoniae and Clinical Infection Characteristics of Different MLST Types

Analysis of Carbapenemase-Resistant Genotypes of Highly Virulent Klebsiella pneumoniae and Clinical Infection Characteristics of Different MLST Types

Multiple Novel Ceftazidime-Avibactam-Resistant Variants of bla _KPC-2 -Positive Klebsiella pneumoniae in Two Patients

Molecular and clinical characterization of hypervirulent Klebsiella pneumoniae isolates from individuals with urinary tract infections

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Co-occurrence of three different plasmids in an extensively drug-resistant hypervirulent Klebsiella pneumoniae isolate causing urinary tract infection

Cited by 13 publications

References 35 publications

Analysis of Carbapenemase-Resistant Genotypes of Highly Virulent Klebsiella pneumoniae and Clinical Infection Characteristics of Different MLST Types

Analysis of Carbapenemase-Resistant Genotypes of Highly Virulent Klebsiella pneumoniae and Clinical Infection Characteristics of Different MLST Types

Multiple Novel Ceftazidime-Avibactam-Resistant Variants of bla KPC-2 -Positive Klebsiella pneumoniae in Two Patients

Molecular and clinical characterization of hypervirulent Klebsiella pneumoniae isolates from individuals with urinary tract infections

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Multiple Novel Ceftazidime-Avibactam-Resistant Variants of bla _KPC-2 -Positive Klebsiella pneumoniae in Two Patients