Virulence factors in carbapenem-resistant hypervirulent Klebsiella pneumoniae

Gabriel Mendes; Maria Leonor Santos; João F Ramalho; Aida Duarte; Cátia Caneiras

doi:10.3389/fmicb.2023.1325077

Virulence factors in carbapenem-resistant hypervirulent Klebsiella pneumoniae

Front Microbiol. 2023 Nov 30:14:1325077. doi: 10.3389/fmicb.2023.1325077. eCollection 2023.

Authors

Gabriel Mendes¹, Maria Leonor Santos¹, João F Ramalho¹, Aida Duarte^{2

3}, Cátia Caneiras^{1

3

4}

Affiliations

¹ Microbiology Research Laboratory on Environmental Health, Institute of Environmental Health (ISAMB), Associate Laboratory TERRA, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal.
² Faculty of Pharmacy, Universidade de Lisboa, Lisbon, Portugal.
³ Egas Moniz Center for Interdisciplinary Research, Egas Moniz School of Health and Science, Almada, Portugal.
⁴ Institute of Preventive Medicine and Public Health, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal.

Abstract

Hypervirulence and carbapenem-resistant have emerged as two distinct evolutionary pathotypes of Klebsiella pneumoniae, with both reaching their epidemic success and posing a great threat to public health. However, as the boundaries separating these two pathotypes fade, we assist a worrisome convergence in certain high-risk clones, causing hospital outbreaks and challenging every therapeutic option available. To better understand the basic biology of these pathogens, this review aimed to describe the virulence factors and their distribution worldwide among carbapenem-resistant highly virulent or hypervirulent K. pneumoniae strains, as well as to understand the interplay of these virulence strains with the carbapenemase produced and the sequence type of such strains. As we witness a shift in healthcare settings where carbapenem-resistant highly virulent or hypervirulent K. pneumoniae are beginning to emerge and replace classical K. pneumoniae strains, a better understanding of these strains is urgently needed for immediate and appropriate response.

Keywords: KPC-variants; Klebsiella pneumoniae; ST11; ST13; ST23; high-risk clones; siderophores; treatment.

Publication types

Review

Grants and funding

The author(s) declare that financial support was received for the research, authorship, and/or publication of this article. This research was partially funded by Fundação para a Ciência e a Tecnologia (FCT), under grant numbers UIDB/04295/2020 and UIDP/04295/2020. Moreover, CC acknowledges the funding provided by the “Research Award in Healthcare Associated Infections” granted by Escola Superior de Saúde Norte da Cruz Vermelha Portuguesa (2019) and by “BInov award,” an innovation award granted by the Southern Regional Section and Autonomous Regions of the Portuguese Pharmaceutical Society (2021). GM was supported by Fundação para a Ciência e Tecnologia (FCT), Portugal, through a Ph.D. Research Studentship Contract (Contrato de Bolsa de Investigação para Doutoramento 2020.07736.BD).