Global surveillance of antimicrobial resistance and hypervirulence in Klebsiella pneumoniae from LMICs: An in-silico approach

Silvester, Reshma; Madhavan, A; Kokkat, Aswin; Parolla, Ajilesh; Adarsh, B.M.; Harikrishnan, M.; Abdulla, Mohamed Hatha

doi:10.1016/j.scitotenv.2021.149859

Cited by 16 publications

(12 citation statements)

References 44 publications

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“…This reflects perhaps an important difference between carriage and clinical strains, as according to the most recent National Antibiotic Resistance Surveillance Report from 2020, antibiotic resistance has been rising in clinical strains in Malaysia [ 39 ]. Regardless of these distinctions, a recent surveillance study of MDR and hv Kp within low- and lower-middle income countries raised the importance of strain convergence [ 40 ]. This phenomenon whereby a hypervirulent and carbapenem-resistant strain arises was noted in 2015 in China [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

“…This phenomenon whereby a hypervirulent and carbapenem-resistant strain arises was noted in 2015 in China [ 41 ]. As such, and for other examples since, Asia was flagged as a region where convergence was of particular concern [ 40 ]. Whilst Malaysia was not one of the three countries highlighted, the circulation of both hv Kp , as shown here, with the many examples above of clinical carbapenemase/ESBL-producing strains is cause for concern.…”

Section: Discussionmentioning

confidence: 99%

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Respiratory carriage of hypervirulent Klebsiella pneumoniae by indigenous populations of Malaysia

Das,

Pandey,

Morris

et al. 2024

BMC Genomics

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Klebsiella pneumoniae is a Gram-negative Enterobacteriaceae that is classified by the World Health Organisation (WHO) as a Priority One ESKAPE pathogen. South and Southeast Asian countries are regions where both healthcare associated infections (HAI) and community acquired infections (CAI) due to extended-spectrum β-lactamase (ESBL)-producing and carbapenem-resistant K. pneumoniae (CRKp) are of concern. As K. pneumoniae can also exist as a harmless commensal, the spread of resistance genotypes requires epidemiological vigilance. However there has been no significant study of carriage isolates from healthy individuals, particularly in Southeast Asia, and specially Malaysia. Here we describe the genomic analysis of respiratory isolates of K. pneumoniae obtained from Orang Ulu and Orang Asli communities in Malaysian Borneo and Peninsular Malaysia respectively. The majority of isolates were K. pneumoniae species complex (KpSC) 1 K. pneumoniae (n = 53, 89.8%). Four Klebsiella variicola subsp. variicola (KpSC3) and two Klebsiella quasipneumoniae subsp. similipneumoniae (KpSC4) were also found. It was discovered that 30.2% (n = 16) of the KpSC1 isolates were ST23, 11.3% (n = 6) were of ST65, 7.5% (n = 4) were ST13, and 13.2% (n = 7) were ST86. Only eight of the KpSC1 isolates encoded ESBL, but importantly not carbapenemase. Thirteen of the KpSC1 isolates carried yersiniabactin, colibactin and aerobactin, all of which harboured the rmpADC locus and are therefore characterised as hypervirulent. Co-carriage of multiple strains was minimal. In conclusion, most isolates were KpSC1, ST23, one of the most common sequence types and previously found in cases of K. pneumoniae infection. A proportion were hypervirulent (hvKp) however antibiotic resistance was low.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Respiratory carriage of hypervirulent Klebsiella pneumoniae by indigenous populations of Malaysia

Das,

Pandey,

Morris

et al. 2024

BMC Genomics

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“…HvKp infection prevalence varies worldwide. Among adults, the prevalence of hvKp was 37.8% (87/230) ( Zhang et al., 2016 ) in China (multicenter, clinical isolates, 2013), 18.6% (26/120) ( Harada et al., 2019 ) in Japan (multicenter, blood isolates only, 2013–2014), 3.7% (17/452) ( Parrott et al., 2021 ) in the USA (New York, invasive isolates only, 2015–2018), 17.8% (157/882) ( Lipworth et al., 2021 ) in the UK (Oxfordshire, blood isolates only, 2008–2018), and 10.9% (267/2432) ( Silvester et al., 2022 ) in lower-middle-income countries (an in-silico analysis of Kp from 33 countries available in the NCBI Pathogen Detection system, 2020). The prevalence estimates in these studies relied on at least one genetic biomarker, similar to our use of five virulence genes to identify hgKp.…”

Section: Discussionmentioning

confidence: 99%

Nosocomial dissemination of hypervirulent Klebsiella pneumoniae with high-risk clones among children in Shanghai

Pan

Wang

et al. 2022

Front. Cell. Infect. Microbiol.

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ObjectivesAlthough hypervirulent Klebsiella pneumoniae (hvKp) is an increasing public health problem, there remains limited epidemiological information regarding hvKp infections in children. Here, we conducted a clinical, molecular and phenotypic surveillance of hvKp strains in a pediatric population.MethodsNon-repetitive K. pneumoniae (Kp) strains consecutively collected during 2019-2020 were screened for hypervirulence genes (prmpA, prmpA2, iucA, iroB, and peg344) using PCR. Positive strains were further characterized by four phenotypic assays (string test, serum killing assay, siderophore production, Galleria mellonella lethality assay), followed by murine sepsis model to determine virulence in vitro and in vivo. Also, capsular types, sequence types, plasmid replicon types, antimicrobial resistance determinants and susceptibility were analyzed.ResultsA total of 352 isolates were collected, wherein 83 (23.6%) were hypervirulence genes-positive Kp (hgKp). A significant increase in KPC-2-producing KL47-ST11 among hgKp strains was observed, from 5.3% (1/19) in 2019 to 67.6% (25/37) in 2020 (P<.0001), suggesting the potential dissemination of the hybrid virulence and carbapenem-resistance encoding plasmid among children. Further, hgKp isolates were classified into hvKp (n = 27) and hgKp-low virulence (hgKp-Lv) (n = 56) based on virulence phenotypic assays. In hvKp, diverse genetic clones were observed and K1-ST23 or K2-ST25 strains with sensitivity to multiple antibiotics were prevalent (25.9%, 7/27). Compared with hgKp-Lv, hvKp infection had a higher propensity to involve severe pneumonia (22.2% vs. 12.5%) in elder children and significant higher mortality in mice (P = 0.0086). Additionally, either hvKp or hgKp-Lv infections were mostly healthcare-associated and hospital-acquired (74.1% vs. 91.9%).ConclusionsThese data suggest that K1-ST23 and K2-ST25 are high-risk clones of hvKp, and the genetic convergence of virulence and carbapenem-resistance is increasing among children. Control measures are needed to prevent the dissemination in clinical settings.

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“…Antimicrobial resistance (AMR) continues to be a growing threat to the global public health ( Silvester et al, 2021 ). Due to the promiscuous nature of plasmids, the resistance mechanism (mediated by a plasmid) are understood to spread horizontally/laterally among bacteria with lightning speed.…”

Section: Introductionmentioning

confidence: 99%

“…Developing countries [that is low-and middle-income countries (LMIC) in Asia, Africa and South America] remain the development/emergence hotspots of AMR—characterized by poor health infrastructure, poor hospital seeking habit, inadequate antimicrobial stewardship programs, unrestricted access to antibiotics, poor record-keeping, and weak or poor governance and regulatory framework ( Ayukekbong et al, 2017 ; Anyanwu et al, 2021a ). Accordingly, the AMR impacts greatly on poor nations that lack disease prevention and affordable treatments facilities ( Silvester et al, 2021 ). For example, Thailand has estimated that superbugs are associated with respective annual death and economic loss of over 38,000 people and US $1.3 billion ( Thamlikitkul et al, 2015 ).…”

Section: Introductionmentioning

confidence: 99%

Mobile Tigecycline Resistance: An Emerging Health Catastrophe Requiring Urgent One Health Global Intervention

et al. 2022

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Mobile tigecycline resistance (MTR) threatens the clinical efficacy of the salvage antibiotic, tigecycline (TIG) used in treating deadly infections in humans caused by superbugs (multidrug-, extensively drug-, and pandrug-resistant bacteria), including carbapenem- and colistin-resistant bacteria. Currently, non-mobile tet(X) and mobile plasmid-mediated transmissible tet(X) and resistance-nodulation-division (RND) efflux pump tmexCD-toprJ genes, conferring high-level TIG (HLT) resistance have been detected in humans, animals, and environmental ecosystems. Given the increasing rate of development and spread of plasmid-mediated resistance against the two last-resort antibiotics, colistin (COL) and TIG, there is a need to alert the global community on the emergence and spread of plasmid-mediated HLT resistance and the need for nations, especially developing countries, to increase their antimicrobial stewardship. Justifiably, MTR spread projects One Health ramifications and portends a monumental threat to global public and animal health, which could lead to outrageous health and economic impact due to limited options for therapy. To delve more into this very important subject matter, this current work will discuss why MTR is an emerging health catastrophe requiring urgent One Health global intervention, which has been constructed as follows: (a) antimicrobial activity of TIG; (b) mechanism of TIG resistance; (c) distribution, reservoirs, and traits of MTR gene-harboring isolates; (d) causes of MTR development; (e) possible MTR gene transfer mode and One Health implication; and (f) MTR spread and mitigating strategies.

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Global surveillance of antimicrobial resistance and hypervirulence in Klebsiella pneumoniae from LMICs: An in-silico approach

Cited by 16 publications

References 44 publications

Respiratory carriage of hypervirulent Klebsiella pneumoniae by indigenous populations of Malaysia

Respiratory carriage of hypervirulent Klebsiella pneumoniae by indigenous populations of Malaysia

Nosocomial dissemination of hypervirulent Klebsiella pneumoniae with high-risk clones among children in Shanghai

Mobile Tigecycline Resistance: An Emerging Health Catastrophe Requiring Urgent One Health Global Intervention

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