Hypervirulent Klebsiella pneumoniae is emerging as an increasingly prevalent K. pneumoniae pathotype responsible for nosocomial and healthcare-associated infections in Beijing, China

Abstract

Objectives Hypervirulent Klebsiella pneumoniae(hvKp) is an increasingly important pathogen. Tracking its epidemiology and evolving antimicrobial resistance will facilitate care. Methods A retrospective study was conducted in two hospitals. We collected the clinical data. Antimicrobial and virulence-associated phenotype and genotype, sequence type, and whole genome sequencing of selected strains were performed. HvKp was defined by the presence of some combination of p rmpA, p rmpA2, iucA, iroB, and peg-344, genes shown to accurately identify hvKp. Results Of 158 Kp clinical isolates, 79 (50%) were hvKp. Interestingly, 53/79 (67.1%) of hvKp strains were isolated from patients with nosocomial infection and 19/79 (24.1%) from patients with healthcare-associated infection, but only 7/79 (8.8%) from patients with community-acquired infections. Importantly, 27/53 (50.9%) and 4/19 (21.1%) of hvKp nosocomial and healthcare-associated isolates, respectively, were multi-drug-resistant (MDR); 25/53 (47.2%) and 5/19 (26.3%) expressed ESBLs and 14/53 (26.4%) and 2/19 (10.5%) were carbapenem-resistant. Of the hvKp isolates from community-acquired infection, 0/7 (0%) were MDR and 0/7 (0%) were carbapenem-resistant. Additionally, unique characteristics of nosocomial, healthcare-associated, and community-acquired hvKp infection were identified. In summary, 50% of K. pneumoniae infections were caused by hvKp. A concerning, novel finding from this report is a major shift in hvKp epidemiology. Ninety-one percent of hvKp infections were nosocomial or healthcare-associated, and 43.1% of these isolates were MDR. Conclusions These data suggest that hvKp may be replacing classical K. pneumoniae as the dominant nosocomial and healthcare-associated pathotype. Ongoing surveillance is needed to determine if this trend is occurring elsewhere.

Clinical and Molecular Characteristics of Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae Isolates in a Tertiary Hospital in Shanghai, China

“…Previous study has showed that young people are susceptible to hypervirulent Klebsiella pneumoniae. 29 However, other studies have showed that the elderly are susceptible to hypervirulent Klebsiella pneumoniae, 24,28 and the present study is consistent with that. Among the 16 isolates of CR-hvKP, except 1 isolate of ST23 CR-hvKP and 1 isolate of ST86 CR-hvKP, the other 14 isolates were all ST11 CR-hvKP.…”

Prevalence, Circulation and Characterization of Multi-resistant Bacteria at Omar Bongo Ondimba Army Instruction Hospital in Libreville

“…Two other studies reported lower prevalence of MRB than that of our study, that of Rabat in Morocco in 2013 [14] with a rate of 45% for the species Klebsiella pneumoniae and that carried out in France in 2014, with 59, 2% for the species Klebsiella pneumonia [15]. In fact, the Klebseilla pneumoniae strain has been described as a typical and major agent responsible for numerous nosocomial epidemics [16].…”

Virulence Factors in Hypervirulent Klebsiella pneumoniae

“…Once nosocomial cKP strains acquire hypervirulence plasmid and colonize in the intestine, healthcare-associated hvKP infections rise indiscriminately (Russo and Marr, 2019). A retrospective study conducted in Beijing by Liu C. et al (2020) found that >90% hvKP-causing infections are nosocomial, suggesting the likelihood of hvKP evolved as a healthcareassociated pathogen. Retrospective studies showed hvKP infections mainly occur in susceptible individuals, male and Russo et al, 2015;Lam et al, 2018b;Choby et al, 2020 aged over 50-years-old, and with an underlying condition of diabetes among (Fazili et al, 2016).…”

“…Except for intrinsic resistance to ampicillin, hvKp strains are commonly susceptible to a variety of antibiotics, including cephalosporins and carbapenems; however, multidrug-resistant and hypervirulent (MDR-hv) strains have recently emerged, primarily due to horizontal transfer of plasmid-mediated resistance or virulence (Liu C. et al, 2020;Tang et al, 2020). The spread of hvKP, including MDR-hvKP strains, poses a serious threat to the public health, and studies on hvKP virulence are therefore imperative to comprehend the underlying pathogenesis and provide a theoretical basis for the treatment and prevention of infection.…”