Epidemicity and clonal replacement of hypervirulent carbapenem-resistant Klebsiella pneumoniae with diverse pathotypes and resistance profiles in a hospital

Na Tang; Yi Li; Shigang Yao; Jinshu Hu; Yingying Zhao; Songzhe Fu; Yuqin Song; Chao Wang; Gang Zhang; Dawei Wei; Chao Li; Rufu Jia; Jie Feng

doi:10.1016/j.jgar.2022.11.007

Epidemicity and clonal replacement of hypervirulent carbapenem-resistant Klebsiella pneumoniae with diverse pathotypes and resistance profiles in a hospital

J Glob Antimicrob Resist. 2023 Mar:32:4-10. doi: 10.1016/j.jgar.2022.11.007. Epub 2022 Nov 17.

Authors

Na Tang¹, Yi Li¹, Shigang Yao¹, Jinshu Hu², Yingying Zhao³, Songzhe Fu⁴, Yuqin Song³, Chao Wang³, Gang Zhang³, Dawei Wei¹, Chao Li³, Rufu Jia², Jie Feng⁵

Affiliations

¹ State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China; College of Life Science, University of Chinese Academy of Sciences, Beijing, China.
² Cangzhou Central Hospital, Cangzhou, China.
³ State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China.
⁴ Key Laboratory of Environment Controlled Aquaculture (KLECA), Ministry of Education, Dalian, China; College of Marine Science and Environment, Dalian Ocean University, Dalian, China.
⁵ State Key Laboratory of Microbial Resources, Institute of Microbiology, Chinese Academy of Sciences, Beijing, China. Electronic address: fengj@im.ac.cn.

PMID: 36400407
DOI: 10.1016/j.jgar.2022.11.007

Abstract

Objectives: The emergence of carbapenem-resistant and hypervirulent Klebsiella pneumoniae (CR-hvKP) poses a great threat to public health. There is a paramount need to increase awareness of the epidemiology, evolution, and pathogenesis of CR-hvKP.

Methods: We collected strains of K. pneumoniae for over two years in a hospital. CR-hvKP strains were screened by polymerase chain reaction (PCR) with primers targeting the virulence genes. Genome sequencing was used to determine phylogenetic relationships and genetic characterization of virulence elements. The population dynamics within these strains were analyzed through epidemiological data. The string test, siderophore secretion, and murine infection experiments were performed to investigate virulence potential of different clones.

Results: A total of 1172 K. pneumoniae strains were isolated from 817 patients, and 125 isolates were identified as CR-hvKP. In all, 102 CR-hvKP strains belonged to sequence type (ST) 11. Genomic analysis demonstrated that three clones of ST11 successively replaced each other in the hospital. Among them, the strains of clade A and clade B acquired virulence plasmids and the strains of clade C acquired a new integrating conjugative element (ICE). Phenotypic experiments revealed enhanced virulence potential of the recent epidemic clone from clade B. Sequence type 11 strains were favorable hosts for the convergence of virulence and resistance, indicated by clonal replacement and acquisition patterns of virulence elements.

Conclusion: The emergence of the enhanced virulence potential of ST11 CR-hvKP suggests that coevolution between hosts and exogenous factors can produce super-virulent CR-hvKP strains, highlighting the need to closely monitor changes in the virulence characteristics of CR-hvKP.

Keywords: Carbapenem resistance; Clonal replacement; Epidemicity; Hypervirulence; ST11.

Publication types

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

MeSH terms

Animals
Carbapenems / pharmacology
Hospitals*
Humans
Klebsiella pneumoniae*
Mice
Phylogeny
Virulence / genetics

Substances

Carbapenems