An Outbreak of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Wenzhou, China
Yajie Zhao,Xiucai Zhang,Von Vergel L. Torres,Haiyang Liu,Andrea Rocker,Yizhi Zhang,Jiawei Wang,Lijiang Chen,Wenzi Bi,Jie Lin,Richard A. Strugnell,Siqin Zhang,Trevor Lithgow,Tieli Zhou,Jianming Cao +14 more
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Infection assays demonstrated high mortality in the Galleria mellonella model with the highest LD50 values for three isolates (<105 CFU/mL) demonstrating the degree of hypervirulence of these CR-hvKP isolates, and is discussed relative to previous outbreaks.Abstract:
Carbapenem-resistant, hypervirulent Klebsiella pneumoniae (CR-hvKP) has recently emerged as a significant threat to public health. In this study, 29 Klebsiella pneumoniae isolates were isolated from eight patients admitted to the intensive care unit (ICU) of a comprehensive teaching hospital located in China from March 2017 to January 2018. Clinical information of patients was the basis for the further analyses of the isolates including antimicrobial susceptibility tests, identification of antibiotic resistance and virulence gene determinants, multilocus sequence typing (MLST), XbaI-macrorestriction by pulsed-field gel electrophoresis (PFGE). Selected isolates representing distinct resistance profiles and virulence phenotypes were screened for hypervirulence in a Galleria mellonella larvae infection model. In the course of the outbreak, the overall mortality rate of patients was 100% (n=8) attributed to complications arising from CR-hvKP infections. All isolates except one (28/29, 96.6%) were resistant to multiple antimicrobial agents, and harbored diverse resistance determinants that included the globally prevalent carbapenemase blaKPC-2. Most isolates had hypervirulent genotypes being positive for nineteen virulence-associated genes, including iutA (25/29, 86.2%), rmpA (27/29, 93.1%), ybtA (27/29, 93.1%), entB (29/29, 100%), fimH (29/29, 100%) and mrkD (29/29, 100%). MLST revealed ST11 for the majority of isolates (26/29, 89,7%). Infection assays demonstrated high mortality in the Galleria mellonella model with the highest LD50 values for three isolates (less than 105 CFU/mL) demonstrating the degree of hypervirulence of these CR-hvKP isolates, and is discussed relative to previous outbreaks of CR-hvKP.read more
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Carbapenem Resistance-Encoding and Virulence-Encoding Conjugative Plasmids in Klebsiella pneumoniae.
TL;DR: Identifying the key molecular markers of resistance and virulence-bearing conjugative plasmids allows improved tracking and control of the life-threatening carbapenem-resistant and hypervirulent strains of K. pneumoniae.
Journal ArticleDOI
Virulence evolution, molecular mechanisms of resistance and prevalence of ST11 carbapenem-resistant Klebsiella pneumoniae in China: A review over the last 10 years.
Wenjian Liao,Yang Liu,Wei Zhang +2 more
TL;DR: This review traces the prevalence of ST11 CRKP in China Antimicrobial Surveillance Network (CHINET), the key drug resistance mechanisms, and virulence evolution, and demonstrates a very close linkage among IncF plasmids, NTEKPC, and ST11 Klebsiella pneumoniae in China.
Journal ArticleDOI
A global perspective on the convergence of hypervirulence and carbapenem resistance in Klebsiella pneumoniae.
TL;DR: In this paper, the emergence of carbapenem-resistant Klebsiella pneumoniae (CR-hvKP) was investigated and three patterns were identified: acquiring a hypervirulent phenotype, acquiring a carbapenzem-resistance phenotype, and acquiring both hypervirulence hybrid plasmid.
Journal ArticleDOI
The Small Protein RmpD Drives Hypermucoviscosity in Klebsiella pneumoniae.
TL;DR: A model in which the RMPA-associated phenotypes are largely due to RmpA activating the expression of rmpD to produce HMV and rmpC to stimulate cps expression is suggested, suggesting that capsule production and HMV may be separable traits.
Posted ContentDOI
The small protein RmpD drives hypermucoviscosity in Klebsiella pneumoniae
TL;DR: A new gene (rmpD) required for HMV but does not contribute to capsule production is identified, which suggests a model in which the RmpA-associated phenotypes are largely due to RMPA activating the expression of rmpD to produce HMV and rmpC to stimulate cps expression.
References
More filters
Journal ArticleDOI
Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing.
Fred C. Tenover,Robert D. Arbeit,Richard V. Goering,P. A. Mickelsen,Barbara E Murray,D. H. Persing,B. Swaminathan +6 more
TL;DR: This research presents a novel, scalable and scalable approach that allows for real-time assessment of the severity of the infection and its impact on patients’ health.
Journal ArticleDOI
Emergence of plasmid-mediated colistin resistance mechanism MCR-1 in animals and human beings in China: A microbiological and molecular biological study
Yiyun Liu,Yang Wang,Timothy R. Walsh,Ling-Xian Yi,Rong Zhang,James Spencer,Yohei Doi,Guo-Bao Tian,Baolei Dong,Xianhui Huang,Lin-Feng Yu,Danxia Gu,Hongwei Ren,Xiaojie Chen,Luchao Lv,Dandan He,Hongwei Zhou,Zi-sen Liang,Jian-Hua Liu,Jianzhong Shen +19 more
TL;DR: The emergence of MCR-1 heralds the breach of the last group of antibiotics, polymyxins, by plasmid-mediated resistance, in Enterobacteriaceae and emphasise the urgent need for coordinated global action in the fight against pan-drug-resistant Gram-negative bacteria.
Journal ArticleDOI
Mechanisms of polymyxin resistance: acquired and intrinsic resistance in bacteria
TL;DR: Current knowledge concerning the different strategies bacteria employ to resist the activities of polymyxins are summarized and increased understanding of these mechanisms is extremely vital and timely to facilitate studies of antimicrobial peptides and find new potential drugs targeting clinically relevant Gram-negative bacteria.
Journal ArticleDOI
Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: A new and dangerous breed
TL;DR: A new hypervirulent (hypermucoviscous) variant of Klebsiella pneumoniae has emerged and the majority of cases described to date are in Asians, raising the issue of a genetic predisposition vs. geospecific strain acquisition.
Journal ArticleDOI
A Novel Virulence Gene in Klebsiella pneumoniae Strains Causing Primary Liver Abscess and Septic Metastatic Complications
TL;DR: It is concluded that magA fits molecular Koch's postulates as a virulence gene and can be used as a marker for the rapid diagnosis and for tracing the source of this emerging infectious disease.