Emergence of Carbapenem-Resistant Serotype K1 Hypervirulent Klebsiella pneumoniae Strains in China

Zhang, Rong; Lin, Dachuan; Chan, Edward Wai Chi; Gu, Danxia; Chen, Gong Xiang; Chen, Sheng

doi:10.1128/aac.02173-15

Cited by 186 publications

(193 citation statements)

References 16 publications

(14 reference statements)

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“…These two isolates were characterized as K2/ST25 and K2/ST65 with blaKPC-2, respectively. The study from China revealed 5 K1 cr-hvKP isolates with plasmid-borne blaKPC-2 gene and genetic relation between 3 of them [30]. The development of resistant strains of hvKP demonstrates a need for avoiding unnecessary antibiotic use that stimulates the generation of resistant strains.…”

Section: Discussionmentioning

confidence: 99%

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Xiao

Yao

Zhou

et al. 2017

J Infect Dev Ctries

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Introduction: Reports of hypermucoviscous Klebsiella pneumoniae (hvKP) isolated from fluids other than blood or abscess are rare. The aim of the study was to compare clinical and microbiological characteristics of hvKP found in blood or abscess fluid with those isolated from other loci. Methodology: A total of 24 non-repetitive hvKP isolates were collected from January 2013 to June 2014 from patients with hvKP infections. There were 15 in Group 1 (fluid other than blood or abscess) and 9 in Group 2 (blood or abscess fluid). Medical records of all patients were reviewed. Capsular polysaccharide (CPS) typing, virulence factor determination, and multilocus sequence typing (MLST) of hvKP isolates were performed. Results: Seventeen sequence types (STs) and 6 capsular serotypes were identified. Type K2 CC65 was most commonly identified in Group 1 and type K2 CC86 in Group 2. Deletion of pLVPK-derived loci were found in K2 and non-K1/K2 hvKP strains. Two virulent genes, fimH and ycfM, were identified more frequently in Group 2 than in Group 1. There was no difference in the frequency of other virulent genes or serotypes in the two groups. Two imipenem resistant hvKP isolates (cr-hvKP) were found in non-blood or abscess samples. Conclusions: hvKP isolated from different body fluids had similar clinical and microbiological characteristics. cr-hvKP identified in non-blood or abscess samples should raise our attention to the challenging situation and management of hvKP infection.

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Section: Discussionmentioning

confidence: 99%

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Xiao

Yao

Zhou

et al. 2017

J Infect Dev Ctries

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“…More importantly, hypervirulent carbapenem-resistant K. pneumoniae isolates have emerged in clinical settings (9,12,16). The confluence of multidrug resistance and enhanced virulence has the potential to be the next clinical crisis (5).…”

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confidence: 99%

“…Aerobactin accounts for increased siderophore production and is a major virulence determinant and new defining trait for hvKP based on genetic background (11). Some advances have been made recently in the epidemiology of hvKP isolates in China (6,7,12), although most of the studies defined hvKP by hypermucoviscosity phenotype rather than genotype, which may have led to biased results. In the present study, hvKP strains were defined on the basis of aerobactin detection.…”

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confidence: 99%

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High Prevalence of Hypervirulent Klebsiella pneumoniae Infection in China: Geographic Distribution, Clinical Characteristics, and Antimicrobial Resistance

Zhang

Zhao

Wang

et al. 2016

Antimicrob Agents Chemother

244

273

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Hypervirulent Klebsiella pneumoniae (hvKP) is traditionally defined by hypermucoviscosity, but data based on genetic background are limited. Antimicrobial-resistant hvKP has been increasingly reported but has not yet been systematically studied. K. pneumoniae isolates from bloodstream infections, hospital-acquired pneumonia, and intra-abdominal infections were collected from 10 cities in China during February to July 2013. Clinical data were collected from medical records. All K. pneumoniae isolates were investigated by antimicrobial susceptibility testing, string test, extended-spectrum ␤-lactamase (ESBL) gene detection, capsular serotypes, virulence gene profiles, and multilocus sequence typing. hvKP was defined by aerobactin detection. Of 230 K. pneumoniae isolates, 37.8% were hvKP. The prevalence of hvKP varied among different cities, with the highest rate in Wuhan (73.9%) and the lowest in Zhejiang (8.3%). Hypermucoviscosity and the presence of K1, K2, K20, and rmpA genes were strongly associated with hvKP (P < 0.001). A significantly higher incidence of liver abscess (P ‫؍‬ 0.026), sepsis (P ‫؍‬ 0.038), and invasive infections (P ‫؍‬ 0.043) was caused by hvKP. Cancer (odds ratio [OR], 2.285) and diabetes mellitus (OR, 2.256) appeared to be independent variables associated with hvKP infections by multivariate analysis. Importantly, 12.6% of hvKP isolates produced ESBLs, and most of them carried bla CTX-M genes. Patients with neutropenia (37.5% versus 5.6%; P ‫؍‬ 0.020), history of systemic steroid therapy (37.5% versus 5.6%; P ‫؍‬ 0.020), and combination therapy (62.5% versus 16.7%; P ‫؍‬ 0.009) were more likely to be infected with ESBL-producing hvKP. The prevalence of hvKP is high in China and has a varied geographic distribution. ESBLproducing hvKP is emerging, suggesting an urgent need to enhance clinical awareness, especially for immunocompromised patients receiving combination therapy. Over the past few decades, increasing rates of hypervirulent Klebsiella pneumoniae (hvKP) infection have been reported worldwide (1-4). Such strains are notorious for their capacity to cause serious and metastatic infections in young and healthy individuals, such as pyogenic liver abscesses and endophthalmitis (5). Hypermucoviscosity is an important in vitro parameter for identification of hvKP (6, 7). However, several controversies have arisen regarding the association of hypermucoviscosity phenotype and virulence (8, 9). Hypermucoviscosity-negative strains are more prone to cause severe infections and have a higher mortality rate in diabetic mice than hypermucoviscous K. pneumoniae (8). Our previous study also demonstrated that one of the five hypermucoviscous K. pneumoniae isolates showed high virulence in both in vitro and in vivo assays (9). Therefore, it is apparent that hvKP cannot be defined by string test alone (10). Aerobactin accounts for increased siderophore production and is a major virulence determinant and new defining trait for hvKP based on genetic background (11). Some advances have been made recently...

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“…Before the study of Danxia et al, there have been 36 CRHvKP strains isolated in China between 2010 and 2018 [13][14][15][16][17][18]. Sequence types and genotypes of β-lactamase (bla) genes of 36 strains were summarized in Table 1.…”

Section: The Analysis Of All Reported Cr-hvkp Strainsmentioning

confidence: 99%

The threat of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-HvKP)

Lee¹,

Park²,

Lee³

et al. 2018

biomedicalresearch

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Klebsiella pneumoniae is one of clinically important opportunistic pathogens responsible for community-acquired and nosocomial infections in immunocompromised individuals. The increasing prevalence of carbapenem-resistant K. pneumoniae (CRKP) poses a serious threat to public health worldwide. With antibiotic resistance, hypervirulent K. pneumoniae (HvKP) responsible for serious disseminated infections in both healthy and immunocompromised individuals has also emerged. Recently, the emergence of carbapenem-resistant hypervirulent K. pneumoniae (CR-HvKP) strains has become a great challenge to public health. In this paper, we discuss the emergence mechanisms of CRHvKP through analyzing features of CR-HvKP strains isolated in China, where both CRKP and HvKP strains are prevalent. These analyses suggest that more extensive surveillance is required to accurately assess the potential threat of the plasmid-mediated convergence of carbapenem-resistance and hypervirulence.

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Emergence of Carbapenem-Resistant Serotype K1 Hypervirulent Klebsiella pneumoniae Strains in China

Cited by 186 publications

References 16 publications

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

Microbiological characteristics of hypermucoviscous Klebsiella pneumoniae isolates from different body fluids

High Prevalence of Hypervirulent Klebsiella pneumoniae Infection in China: Geographic Distribution, Clinical Characteristics, and Antimicrobial Resistance

The threat of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-HvKP)

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