Co-occurrence of three different plasmids in an extensively drug-resistant hypervirulent Klebsiella pneumoniae isolate causing urinary tract infection

Xiaokui Zhu; Chuanyu Sun; Hongyin Chen; Xiaodie Zhan; Chenxin Liu; Xin Liu; Changwu Yue; Hong Song; Hongling Lu; Xu Jia

doi:10.1016/j.jgar.2020.09.002

Co-occurrence of three different plasmids in an extensively drug-resistant hypervirulent Klebsiella pneumoniae isolate causing urinary tract infection

J Glob Antimicrob Resist. 2020 Dec:23:203-210. doi: 10.1016/j.jgar.2020.09.002. Epub 2020 Sep 20.

Authors

Xiaokui Zhu¹, Chuanyu Sun², Hongyin Chen³, Xiaodie Zhan³, Chenxin Liu³, Xin Liu³, Changwu Yue⁴, Hong Song⁵, Hongling Lu⁶, Xu Jia⁷

Affiliations

¹ Department of Biochemistry, Zunyi Medical University, Zunyi, Guizhou, China.
² Huashan Hospital, Fudan University, Shanghai, China.
³ Non-coding RNA and Drug Discovery Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, Sichuan, China.
⁴ Key Laboratory of Microbial Drugs Innovation and Transformation, Medical College, Yan'an University, Yan'an, Shaanxi, China.
⁵ Department of Microbiology, Zunyi Medical University, Zunyi, Guizhou, China.
⁶ Department of Biochemistry, Zunyi Medical University, Zunyi, Guizhou, China. Electronic address: l_hongling2@163.com.
⁷ Non-coding RNA and Drug Discovery Key Laboratory of Sichuan Province, Chengdu Medical College, Chengdu, Sichuan, China. Electronic address: jiaxu@cmc.edu.cn.

PMID: 32966911
DOI: 10.1016/j.jgar.2020.09.002

Abstract

Objectives: A single carbapenem-resistant, hypervirulent Klebsiella pneumoniae strain has attracted major public concern. The aim of the present study was to better understand the antimicrobial resistance and genetic characteristics of Klebsiella pneumoniae strain XJ-K1.

Methods: Klebsiella pneumoniae strain XJ-K1 was isolated from a urine specimen of a 69-year-old male patient in a teaching hospital in Shanghai, China, in January 2018. Antimicrobial susceptibility testing, string test, whole-genome sequencing, bioinformatics analysis and phylogenetic analysis were performed in this study.

Results: Klebsiella pneumoniae XJ-K1 was an extensively drug-resistant (XDR) hypervirulent strain that showed high-level resistance to antibacterial agents. Three novel plasmids were discovered in strain XJ-K1, including a 207,409-bp IncHI1B-type rmpA2-bearing pLVPK-like virulence plasmid, a 130,628-bp Col156/IncFIB/IncFII-type aadA2-, sul1-, mph(A)- and dfrA12-bearing MDR plasmid, and a 99,408-bp IncFII/IncR-type bla_KPC-2-, bla_TEM-1-, bla_CTX-M-65-, bla_SHV-12-, rmtB- and fosA3-bearing MDR plasmid. Sequence analysis of the chromosome revealed that the aadA2, fosA and sul1 genes were harboured by XJ-K1. Multilocus sequence typing (MSLT) showed that XJ-K1 was ST11.

Conclusions: A large number of resistance genes and a pLVPK-like virulence plasmid carried by Klebsiella pneumoniae strain XJ-K1 might be the main reasons leading to the XDR and hypervirulent phenotype. To the best of our knowledge, this is the first report in China on the co-occurrence of a pLVPK-like virulence plasmid and two MDR plasmids in a single ST11 XDR and hypervirulent Klebsiella pneumoniae isolated from patient urine, which is a serious concern for its further spread.

Keywords: Extensively drug-resistant; Hypervirulent; Klebsiella pneumoniae; Plasmid; ST11.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Aged
China
Humans
Klebsiella Infections*
Klebsiella pneumoniae / genetics
Male
Pharmaceutical Preparations*
Phylogeny
Plasmids / genetics
Urinary Tract Infections*
beta-Lactamases / genetics

Substances

Pharmaceutical Preparations
beta-Lactamases