Prevalence of hypervirulent and carbapenem-resistant Klebsiella pneumoniae under divergent evolutionary patterns

Dongxing Tian; Xiao Liu; Wenjie Chen; Ying Zhou; Dakang Hu; Weiwen Wang; Jinzuan Wu; Qing Mu; Xiaofei Jiang

doi:10.1080/22221751.2022.2103454

Prevalence of hypervirulent and carbapenem-resistant Klebsiella pneumoniae under divergent evolutionary patterns

Emerg Microbes Infect. 2022 Dec;11(1):1936-1949. doi: 10.1080/22221751.2022.2103454.

Authors

Dongxing Tian¹, Xiao Liu², Wenjie Chen³, Ying Zhou^{1

4}, Dakang Hu¹, Weiwen Wang¹, Jinzuan Wu⁵, Qing Mu², Xiaofei Jiang¹

Affiliations

¹ Department of Clinical Laboratory, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
² School of Pharmacy, Fudan University, Shanghai, People's Republic of China.
³ Department of Infectious Disease, Huashan Hospital, Fudan University, Shanghai, People's Republic of China.
⁴ Department of Clinical Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, People's Republic of China.
⁵ Department of Clinical Laboratory, Pingyang Hospital of Wenzhou Medical University, Wenzhou, People's Republic of China.

Abstract

K1/K2 hvKP strains acquire carbapenem-resistance plasmids, known as CR-hvKp, and carbapenem-resistant Klebsiella pneumoniae (CRKP) strains obtain virulence plasmids, recognized as hv-CRKP. The two different evolution patterns of hypervirulent combined carbapenem-resistant Klebsiella pneumoniae may lead to their different prevalence in hospitals. Our study aimed to investigate the prevalence of hv-CRKP and CR-hvKp strains and to analyze factors influencing their evolution and prevalence. We collected 890 K. pneumoniae genomes from GenBank and 530 clinical K. pneumoniae isolates from nine hospitals. Our study found that hv-CRKP strains were more prevalent than CR-hvKp strains and both were dominated by bla_KPC-2 gene. The bla_KPC-2-carrying plasmids could mobilize non-conjugative virulence plasmids from hvKp strains to CRKP strains. The conserved oriT of virulence plasmids and the widespread of conjugative helper plasmids were potential factors for the mobilization of non-conjugative virulence plasmids. HvKp strains with KPC plasmid could hardly simultaneously exhibit hypervirulence and carbapenem resistance as CRKP strains with virulence plasmid, and we found that rfaH mutation reduced capsular synthesis and increased carbapenem resistance of the CR-hvKp strain. In summary, this study revealed that hv-CRKP strains were more suitable for survival in hospital settings than CR-hvKp strains and the widespread conjugative KPC-producing plasmids contributed to the emergence and prevalence of hv-CRKP strains.

Keywords: Hypervirulent; carbapenem resistance; conjugation; genome evolution; oriT.

MeSH terms

Anti-Bacterial Agents / pharmacology
Carbapenem-Resistant Enterobacteriaceae* / genetics
Carbapenems / pharmacology
Humans
Klebsiella Infections* / epidemiology
Klebsiella pneumoniae
Plasmids / genetics
Prevalence
Serogroup
beta-Lactamases / genetics

Substances

Anti-Bacterial Agents
Carbapenems
beta-Lactamases

Grants and funding

This work was supported by National Natural Science Foundation of China under Grant 81871692 and 82172315; Science and Technology Commission of Shanghai Municipality under Grant 19JC1413002; Shanghai Municipal Key Clinical Specialty under grant shslczdzk0330; Jiaxing Municipal Key Laboratory of Infectious Diseases and Bacterial Drug Resistance.