Epidemiological characteristics an outbreak of ST11 multidrug-resistant and hypervirulent Klebsiella pneumoniae in Anhui, China

Zhien He; Weifeng Xu; Hang Zhao; Wei Li; Yuanyuan Dai; Huaiwei Lu; Liping Zhao; Changfeng Zhang; Yujie Li; Baolin Sun

doi:10.3389/fmicb.2022.996753

Epidemiological characteristics an outbreak of ST11 multidrug-resistant and hypervirulent Klebsiella pneumoniae in Anhui, China

Front Microbiol. 2022 Sep 23:13:996753. doi: 10.3389/fmicb.2022.996753. eCollection 2022.

Authors

Zhien He¹, Weifeng Xu¹, Hang Zhao², Wei Li¹, Yuanyuan Dai³, Huaiwei Lu³, Liping Zhao¹, Changfeng Zhang⁴, Yujie Li¹, Baolin Sun¹

Affiliations

¹ Department of Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
² College of Life Science and Technology, Mudanjiang Normal University, Mudanjiang, China.
³ Department of Clinical Laboratory, Anhui Provincial Hospital of Anhui Medical University of China, Hefei, China.
⁴ Clinical Laboratory Center, First Affiliated Hospital, Anhui University of Traditional Chinese Medicine, Hefei, China.

Abstract

Klebsiella pneumoniae has become a primary threat to global health because of its virulence and resistance. In 2015, China reported multidrug-resistant (MDR) and hypervirulent K. pneumoniae (hvKp) isolates. The emergence of MDR-hvKp poses a significant threat to public health. We collected 76 MDR K. pneumoniae isolates from the same hospital, of which there were a total of six MDR-hvKp isolates. We performed multilocus sequence typing (MLST) and capsular typing, whole genome sequencing, comparative genome analysis, and phylogenetic analysis as well as phenotypic experiments, including growth curves, mucoviscosity assay, Galleria mellonella infection model, human whole blood survival, and human neutrophil bactericidal assay to further characterize the samples. We identified six large plasmids carrying extended spectrum β-lactamase (ESBL) genes or carbapenemase genes (bla _CTX-M-65, bla _KPC-2, bla _SHV-12, bla _SHV-158), 9 plasmids containing other drug resistance genes, and 7 hypervirulence plasmids carrying rmpA and rmpA2 in ST11 MDR-hvKp isolates. Some of these plasmids were identical, whereas others differed only by insertion elements. In addition, we identified a plasmid, p21080534_1, that carries hypervirulence genes (iucABCD, iutA, rmpA2), a carbapenemase gene (bla _KPC-2), and an ESBL gene (bla _SHV-12), as well as MDR-hvKp 21072329, which did not carry rmpA or rmpA2, but exhibited hypervirulence and hypermucoviscosity. ST11 MDR-hvKp derived from hypervirulence and multidrug resistance plasmids not only causes significant treatment difficulties, but also represents an unprecedented challenge to public health. Therefore, urgent measures are needed to limit further spread.

Keywords: Klebsiella pneumonia; extended-spectrum β-lactamase; multidrug-resistant and hypervirulent Klebsiella pneumoniae (MDR-hvKp); virulence plasmid; whole genome sequencing.

Grants and funding

This research was supported by the National Key Research and Development Program of China (2021YFC2300300), the Strategic Priority Research Program of the Chinese Academy of Sciences (XDB29020000), grants from the National Natural Science Foundation of China (32070132), and the Fundamental Research Funds for the Central Universities (YD9100002013).