Evolution of Carbapenem-Resistant Serotype K1 Hypervirulent Klebsiella pneumoniae by Acquisition of bla _VIM-1 -Bearing Plasmid

Abstract

We report the identification of a carbapenem-resistant, hypervirulent Klebsiella pneumoniae (hvKp) strain which produced the carbapenemase VIM-1. Genomic analysis showed that the strain belonged to sequence type ST23 and serotype K1, a major hvKp clone, and harbored three resistance-encoding plasmids. Among them, a blaVIM-1-bearing plasmid was found to possess a mosaic structure presumably generated by multiple gene mobilization events. This finding indicates that hvKp actively acquires mobile resistance-encoding elements, facilitating simultaneous expression of hypervirulence and carbapenem-resistance.

Co-occurrence of Rapid Gene Gain and Loss in an Interhospital Outbreak of Carbapenem-Resistant Hypervirulent ST11-K64 Klebsiella pneumoniae

“…Strain KP20194d, isolated from patient 4, and strain KP20194c, isolated from patient 3, shared the loss of a 10-kbp fragment from plasmid p2 which contained rmtB (Figures 1, 2), suggesting the transmission from patient 3 to patient 4 given the timeline and the use of the same bed and ventilator. The emergence of the CR-hvKP strains can result from the acquisition of either a carbapenemase-producing plasmid by a hypervirulent strain, usually belonging to serotype ST23 and capsular type K1/K2 (Yao et al, 2015;Dong et al, 2019;Shen et al, 2019); or a pLVKP-like virulence plasmid by CRKP strains, among which ST11 is dominant in China (Wei et al, 2016;Ruan et al, 2020;Yang et al, 2020). Our strains likely fit into the latter category, because MLST and Kaptive software analyses indicated that our 13 strains belonged to ST11-K64, and also because of the existence of the pLVPK-like virulence plasmid (Figure 3).…”

One Health or Three? Transmission modelling ofKlebsiellaisolates reveals ecological barriers to transmission between humans, animals and the environment

“…Two of these (K.mic SPARK_1816_C1 and K.gri SPARK_1652_C1) present nearly identical genotypic and phenotypic resistance profiles to each other, as well as to five isolates of K.pne. This resistance profile is characterised by the presence of bla SHV-12 , bla VIM-1 , mph(A), and qnrS genes, harboured by a class 1 integron (GenBank accession number MN783743) associated with the highly conjugative IncA plasmid pR210-2-VIM 47 . This plasmid is known to be circulating in multiple Enterobacteriacae species in Italy 48 , and the re-emergence of VIM-1 in this region is thought to reflect the increased use of ceftazidime-avibactam (CAZ-AZI) to treat with KPC-producing bacteria.…”

Epidemiological Characteristics and Formation Mechanisms of Multidrug-Resistant Hypervirulent Klebsiella pneumoniae

“…Apart from this MDR plasmid, this strain carried another two plasmids, including its virulence plasmid (Xie et al, 2018). In Dong et al (2019) study, a VIM-1-producing K1 ST23 CR-HvKP strain harbored three plasmids; a virulence plasmid highly homologous to that recovered from other ST23 hvKPs; and a bla VIM-1bearing plasmid possessing a unique resistance island structure presumably generated by multiple gene mobilization events. Yuan et al (2019) showed that apart from an IncHI1/IncFIB pLVPK-like plasmid, a bla NDM-5 -carrying K54 ST29 CR-HvKP isolated from Sichuan, China, harbored a bla NDM-5 -carrying IncX3 self-transmissible plasmid.…”