The making of hypervirulent <i>Klebsiella pneumoniae</i>

Dai, Piaopiao; Hu, Dakang

doi:10.1002/jcla.24743

Cited by 19 publications

(19 citation statements)

References 259 publications

(561 reference statements)

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“…Virulence-related genes mrk coding for type 3 fimbriae and ybt coding for yersiniabactin in the chromosome, aerobactin genes iuc/iutA and salmochelin gene iro in pLVPK-like virulence plasmid were found in PBR-hvKP [40]. Four PBR-hvKP isolates in this study carried rmpA and rmpA2.…”

Section: Discussionmentioning

confidence: 57%

Clonal transmission of polymyxin B-resistant hypervirulent Klebsiella pneumoniae isolates coharboring blaNDM-1 and blaKPC-2 in a tertiary hospital in China

Tang

Liu

et al. 2023

BMC Microbiol

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Background The prevalence of multidrug-resistant hypervirulent K. pneumoniae (MDR-hvKP) has gradually increased. It poses a severe threat to human health. However, polymyxin-resistant hvKP is rare. Here, we collected eight polymyxin B-resistant K. pneumoniae isolates from a Chinese teaching hospital as a suspected outbreak. Results The minimum inhibitory concentrations (MICs) were determined by the broth microdilution method. HvKP was identified by detecting virulence-related genes and using a Galleria mellonella infection model. Their resistance to serum, growth, biofilm formation, and plasmid conjugation were analyzed in this study. Molecular characteristics were analyzed using whole-genome sequencing (WGS) and mutations of chromosome-mediated two-component systems pmrAB and phoPQ, and the negative phoPQ regulator mgrB to cause polymyxin B (PB) resistance were screened. All isolates were resistant to polymyxin B and sensitive to tigecycline; four were resistant to ceftazidime/avibactam. Except for KP16 (a newly discovered ST5254), all were of the K64 capsular serotype and belonged to ST11. Four strains co-harbored blaKPC-2, blaNDM-1, and the virulence-related genes prmpA, prmpA2, iucA, and peg344, and were confirmed to be hypervirulent by the G. mellonella infection model. According to WGS analysis, three hvKP strains showed evidence of clonal transmission (8–20 single nucleotide polymorphisms) and had a highly transferable pKOX_NDM1-like plasmid. KP25 had multiple plasmids carrying blaKPC-2, blaNDM-1, blaSHV-12, blaLAP-2, tet(A), fosA5, and a pLVPK-like virulence plasmid. Tn1722 and multiple additional insert sequence-mediated transpositions were observed. Mutations in chromosomal genes phoQ and pmrB, and insertion mutations in mgrB were major causes of PB resistance. Conclusions Polymyxin-resistant hvKP has become an essential new superbug prevalent in China, posing a serious challenge to public health. Its epidemic transmission characteristics and mechanisms of resistance and virulence deserve attention.

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Section: Discussionmentioning

confidence: 57%

Clonal transmission of polymyxin B-resistant hypervirulent Klebsiella pneumoniae isolates coharboring blaNDM-1 and blaKPC-2 in a tertiary hospital in China

Tang

Liu

et al. 2023

BMC Microbiol

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“…The de nition of hvKP has not been clearly outlined and indeed, none of the phenotypic or genotypic tests alone is speci c for hypervirulence. However, the presence of hypercapsule, macromolecular exopolysaccharide or excessive siderophores in hvKP and not in classical K. pneumoniae (cKP) strains suggest that these are signi cant virulence contributors to the observed hypervirulence [4]. Nonetheless, it has been di cult to ascertain which is the role of each virulence factor and the degree of involvement in these strains.…”

Section: Discussionmentioning

confidence: 99%

Diversity of hypervirulent Klebsiella pneumoniae clones causing cryptogenic liver abscesses and metastatic complications in Argentina.

Nannini,

Lahitte,

Scapellato

et al. 2024

Preprint

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Cryptogenic liver abscesses (CLA) caused by hypervirulent Klebsiella pneumoniae (hvKP) strains are emerging in western countries. The aim of the study was to describe the clinical characteristics of patients from Argentina with hvKP-related CLA and the analysis of isolated strains. A retrospective chart review of 15 patients hospitalized in 8 hospitals of Argentina between October 2015 and November 2018 was performed. PCR for genes associated with capsular and multilocus sequence (MLST) determination and virulence factors were done in 8 hvKP isolates from these patients. We found that the mean age was 60 years and 73% were men; 40% had diabetes. Sixty percent had bacteremia and 73% had ≥1 metastatic foci of infection. There was no in-hospital death but 2 patients with endophthalmitis required eye enucleation. From the 8 studied isolates, 4 belonged to K1 and 4 to K2 serotypes, the rpmA and iroB genes were present in all of them, and 7 and 5 also harbored the iucA and the rmpA2 gene, respectively. MSLT analysis showed that most of the K1 serotypes belonged to ST23 while a diverse MLST pattern was seen with K2 strains. In addition, the four hvKP strains associated to metastatic complications, belonging to three distinct sequence types, were positive to the rpmA, iroB and iuc virulence genes. We could show an important morbidity associated with this syndrome in Argentina, a significant diversity in the hvKP clones causing CLA in Argentina, and the potential utility of the rpmA and iroB genes as predictors of virulence.

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“…Klebsiella pneumoniae is an important nosocomial pathogen increasingly associated with resistance and, at least among some community-acquired types, with hypervirulence [1][2][3]. The latter, predominantly belonging to sequence types (STs) 23, 86 and 65 of capsular types K1 and K2, carry virulence plasmids containing siderophores, heavy metal resistance genes and regulators of mucoviscosity genes rmpA/rmpA2 [4,5]. These plasmids are generally non-conjugative, but in some cases have combined with conjugative resistance plasmids to become conjugative hybrid resistance/virulence plasmids [6,7].…”

Section: Introductionmentioning

confidence: 99%

Klebsiella pneumoniae sequence type 147: a high-risk clone increasingly associated with plasmids carrying both resistance and virulence elements

Turton,

Perry,

McGowan

et al. 2024

Journal of Medical Microbiology

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Introduction. The first hybrid resistance/virulence plasmid, combining elements from virulence plasmids described in hypervirulent types of Klebsiella pneumoniae with those from conjugative resistance plasmids, was described in an isolate of sequence type (ST) 147 from 2016. Subsequently, this type has been increasingly associated with these plasmids. Hypothesis or gap statement. The extent of carriage of hybrid virulence/resistance plasmids in nosocomial isolates of K. pneumoniae requires further investigation. Aim. To describe the occurrence of virulence/resistance plasmids among isolates of K. pneumoniae received by the UK reference laboratory, particularly among representatives of ST147, and to compare their sequences. Methodology. Isolates received by the laboratory during 2022 and the first half of 2023 (n=1278) were screened for virulence plasmids by PCR detection of rmpA/rmpA2 and typed by variable-number tandem repeat analysis. Twenty-nine representatives of ST147 (including a single-locus variant) from seven hospital laboratories were subjected to long-read nanopore sequencing using high-accuracy q20 chemistry to provide complete assemblies. Results. rmpA/rmpA2 were detected in 110 isolates, of which 59 belonged to hypervirulent K1-ST23, K2-ST86 and K2-ST65/375. Of the remainder, representatives of ST147 formed the largest group, with 22 rmpA/rmpA2-positive representatives (out of 47 isolates). Representatives were from 19 hospital laboratories, with rmpA/rmpA2-positive isolates from 10. Nanopore sequencing of 29 representatives of ST147 divided them into those with no virulence plasmid (n=12), those with non-New Delhi metallo-β-lactamase (NDM) virulence plasmids (n=6) and those carrying bla NDM-5 (n=9) or bla NDM-1 (n=2) virulence plasmids. These plasmids were of IncFIB(pNDM-Mar)/IncHI1B(pNDM-MAR) replicon types. Most of the non-NDM virulence plasmids were highly similar to the originally described KpvST147L_NDM plasmid. Those carrying bla NDM-5 were highly similar to one another and to previously described plasmids in ST383 and carried an extensive array of resistance genes. Comparison of the fully assembled chromosomes indicated multiple introductions of ST147 in UK hospitals. Conclusion. This study highlights the high proportion of representatives of ST147 that carry IncFIB(pNDM-Mar)/IncHI1B(pNDM-MAR) hybrid resistance virulence plasmids. It is important to be aware of the high probability that representatives of this type carry these plasmids combining resistance and virulence determinants and of the consequent increased risk to patients.

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The making of hypervirulent Klebsiella pneumoniae

Cited by 19 publications

References 259 publications

Clonal transmission of polymyxin B-resistant hypervirulent Klebsiella pneumoniae isolates coharboring blaNDM-1 and blaKPC-2 in a tertiary hospital in China

Clonal transmission of polymyxin B-resistant hypervirulent Klebsiella pneumoniae isolates coharboring blaNDM-1 and blaKPC-2 in a tertiary hospital in China

Diversity of hypervirulent Klebsiella pneumoniae clones causing cryptogenic liver abscesses and metastatic complications in Argentina.

Klebsiella pneumoniae sequence type 147: a high-risk clone increasingly associated with plasmids carrying both resistance and virulence elements

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