Emergence of a Multidrug-Resistant Hypervirulent Klebsiella pneumoniae Sequence Type 23 Strain with a Rare
            <i>bla</i>
            <sub>CTX-M-24</sub>
            -Harboring Virulence Plasmid

Shen, Dejian; Ma, Ge; Li, Cuidan; Jia, Xiaoyun; Qin, Chuan; Yang, Tingting; Wang, Lifeng; Jiang, Xiaoyuan; Ding, Nan; Zhang, Xiuli; Yue, Liya; Yin, Zhe; Zeng, Lijun; Zhao, Yongliang; Zhou, Dongsheng; Chen, Fei

doi:10.1128/aac.02273-18

Cited by 52 publications

(39 citation statements)

References 15 publications

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“…This is consistent with their local dissemination or recent acquisition from a common source, a finding supported by the discovery of four novel but similar iuc3 encoding plasmids in these isolates. Of greatest concern was the detection of at least nine distinct convergence events between AMR and hypervirulence (encompassing 7·3% of isolates) plus seven novel dual AMR + iuc containing plasmids, increasing the total number of convergent plasmids reported so far by almost 50% [49,[80][81][82][83]. Given that our isolate collection represented a snapshot from seven diagnostic laboratories, we predict that many additional convergent plasmid variants await future identification.…”

Section: Discussionmentioning

confidence: 99%

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

et al. 2020

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Background: Klebsiella pneumoniae is a leading cause of bloodstream infection (BSI). Strains producing extendedspectrum beta-lactamases (ESBLs) or carbapenemases are considered global priority pathogens for which new treatment and prevention strategies are urgently required, due to severely limited therapeutic options. South and Southeast Asia are major hubs for antimicrobial-resistant (AMR) K. pneumoniae and also for the characteristically antimicrobial-sensitive, community-acquired "hypervirulent" strains. The emergence of hypervirulent AMR strains and lack of data on exopolysaccharide diversity pose a challenge for K. pneumoniae BSI control strategies worldwide. Methods: We conducted a retrospective genomic epidemiology study of 365 BSI K. pneumoniae from seven major healthcare facilities across South and Southeast Asia, extracting clinically relevant information (AMR, virulence, K and O antigen loci) using Kleborate, a K. pneumoniae-specific genomic typing tool. Results: K. pneumoniae BSI isolates were highly diverse, comprising 120 multi-locus sequence types (STs) and 63 Kloci. ESBL and carbapenemase gene frequencies were 47% and 17%, respectively. The aerobactin synthesis locus (iuc), associated with hypervirulence, was detected in 28% of isolates. Importantly, 7% of isolates harboured iuc plus ESBL and/or carbapenemase genes. The latter represent genotypic AMR-virulence convergence, which is generally considered a rare phenomenon but was particularly common among South Asian BSI (17%). Of greatest concern, we identified seven novel plasmids carrying both iuc and AMR genes, raising the prospect of co-transfer of these phenotypes among K. pneumoniae.Conclusions: K. pneumoniae BSI in South and Southeast Asia are caused by different STs from those predominating in other regions, and with higher frequency of acquired virulence determinants. K. pneumoniae carrying both iuc and AMR genes were also detected at higher rates than have been reported elsewhere. The study demonstrates how genomics-based surveillance-reporting full molecular profiles including STs, AMR, virulence and serotype locus information-can help standardise comparisons between sites and identify regional differences in pathogen populations.

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Section: Discussionmentioning

confidence: 99%

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

et al. 2020

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“…Moreover it is well-established that strains from the most virulent K. pneumoniae sequence type ST23 remain less resistant to antibiotics -primarily to fluoroquinolonesthan isolates from the MDR major international STs (Cejas et al, 2014;Qu et al, 2015;Cheong et al, 2016;Yan et al, 2016;Chen Y.T. et al, 2017;Ku et al, 2017;Lu et al, 2017;Sturm et al, 2018;Shen et al, 2019). Moreover, similarly to the most virulent MRSA clone, ST121, no high-level resistance to fluoroquinolones has been reported in any ST23 K. pneumoniae strain to date.…”

Section: The Virulence Component In Mdr K Pneumoniaementioning

confidence: 99%

Global Evolution of Pathogenic Bacteria With Extensive Use of Fluoroquinolone Agents

2020

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“…First reported in the mid-1980s in Taiwan, ST23 was often mentioned to present and strongly associated with the K1 capsular serotype [ 24 ]. The K. pneumoniae ST23 strains were confirmed as multidrug-resistant hypervirulent pathogens causing abscesses of the kidneys, pancreas, liver [ 25 ], and endogenous endophthalmitis [ 26 ], with dominance in the Asian Pacific region [ 27 ]. In fact, it means the 4 cases of asymptomatic colonization of the infant intestinal tract by hypervirulent strains of MDRKP that spread a short time ago and may be accounted as a hospital-acquired infection.…”

Section: Resultsmentioning

confidence: 99%

Multidrug-Resistant Hypervirulent Klebsiella pneumoniae Found Persisting Silently in Infant Gut Microbiota

Vasilyev

Nikolaeva

Siniagina

et al. 2020

International Journal of Microbiology

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Since the spread of multidrug-resistant Klebsiella pneumoniae (MDRKP) strains is considered as a challenge for patients with weakened or suppressed immunity, the emergence of isolates carrying determinants of hypervirulent phenotypes in addition may become a serious problem even for healthy individuals. The aim of this study is an investigation of the nonoutbreak K. pneumoniae emergence occurred in early 2017 at a maternity hospital of Kazan, Russia. Ten bacterial isolates demonstrating multiple drug resistance phenotypes were collected from eight healthy full-term breastfed neonates, observed at the maternity hospital of Kazan, Russia. All the infants and their mothers were dismissed without symptoms or complaints, in a satisfactory condition. Whole-genome shotgun (WGS) sequencing was performed with the purpose to track down a possible spread source(s) and obtain detailed information about resistance determinants and pathogenic potential of the collected isolates. Microdilution tests have confirmed production of extended-spectrum β-lactamases (ESBL) and their resistance to aminoglycoside, β-lactam, fluoroquinolone, sulfonamide, nitrofurantoin, trimethoprim, and fosfomycin antibiotics and Klebsiella phage. The WGS analysis has revealed the genes that are resistant to aminoglycosides, fluoroquinolones, macrolides, sulfonamides, chloramphenicols, tetracyclines, and trimethoprim and ESBL determinants. The pangenome analysis had split the isolates into two phylogenetic clades. The first group, a more heterogeneous clade, was represented by 5 isolates with 4 different in silico multilocus sequence types (MLSTs). The second group contained 5 isolates from infants born vaginally with the single MLST ST23, positive for genes corresponding to hypervirulent phenotypes: yersiniabactin, aerobactin, salmochelin, colibactin, hypermucoid determinants, and specific alleles of K- and O-antigens. The source of the MDRKP spread was not defined. Infected infants have shown no developed disease symptoms.

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Emergence of a Multidrug-Resistant Hypervirulent Klebsiella pneumoniae Sequence Type 23 Strain with a Rare bla _CTX-M-24 -Harboring Virulence Plasmid

Cited by 52 publications

References 15 publications

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

Global Evolution of Pathogenic Bacteria With Extensive Use of Fluoroquinolone Agents

Multidrug-Resistant Hypervirulent Klebsiella pneumoniae Found Persisting Silently in Infant Gut Microbiota

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Emergence of a Multidrug-Resistant Hypervirulent Klebsiella pneumoniae Sequence Type 23 Strain with a Rare bla CTX-M-24 -Harboring Virulence Plasmid

Cited by 52 publications

References 15 publications

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

Global Evolution of Pathogenic Bacteria With Extensive Use of Fluoroquinolone Agents

Multidrug-Resistant Hypervirulent Klebsiella pneumoniae Found Persisting Silently in Infant Gut Microbiota

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Emergence of a Multidrug-Resistant Hypervirulent Klebsiella pneumoniae Sequence Type 23 Strain with a Rare bla _CTX-M-24 -Harboring Virulence Plasmid