Epidemiological Characteristics and Formation Mechanisms of Multidrug-Resistant Hypervirulent Klebsiella pneumoniae

Multi-drug resistance (MDR) and hypervirulence (hv) were exhibited by different well-separated Klebsiella pneumoniae lineages in the past, but their convergence clones—MDR-hypervirulent K. pneumoniae (HvKPs)—both highly pathogenic and resistant to most available antibiotics, have increasingly been reported. In light of the clonal lineages and molecular characteristics of the studied MDR-HvKP strains found in the literature since 2014, this review discusses the epidemiology of MDR-HvKPs, in particular summarizing the three general aspects of plasmids-associated mechanisms underlying the formation of MDR-HvKPs clones: MDR-classic K. pneumoniae (cKPs) acquiring hv plasmids, hvKPs obtaining MDR plasmids, and the acquisition of hybrid plasmids harboring virulence and resistance determinants. A deeper understanding of epidemiological characteristics and possible formation mechanisms of MDR-HvKPs is greatly needed for the proper surveillance and management of this potential threat.

[1]  Qi Xu,et al.  Conjugation of Virulence Plasmid in Clinical Klebsiella pneumoniae Strains through Formation of a Fusion Plasmid , 2020, Advanced biosystems.

[2]  K. Holt,et al.  Population genomics of Klebsiella pneumoniae , 2020, Nature Reviews Microbiology.

[3]  P. Kyberd,et al.  Mechanisms of , 2020 .

[4]  N. Saitou,et al.  Population Genomics , 2019, Population Genomics.

[5]  Ting Yu,et al.  Isolation and characterization of a sequence type 25 carbapenem-resistant hypervirulent Klebsiella pneumoniae from the mid-south region of China , 2019, BMC Microbiology.

[6]  F. Davies,et al.  Hybrid Resistance and Virulence Plasmids in “High-Risk” Clones of Klebsiella pneumoniae, Including Those Carrying blaNDM-5 , 2019, Microorganisms.

[7]  Chengwen Li,et al.  blaNDM-5 carried by a hypervirulent Klebsiella pneumoniae with sequence type 29 , 2019, Antimicrobial Resistance & Infection Control.

[8]  Rong Zhang,et al.  Evolution of Carbapenem-Resistant Serotype K1 Hypervirulent Klebsiella pneumoniae by Acquisition of blaVIM-1-Bearing Plasmid , 2019, Antimicrobial Agents and Chemotherapy.

[9]  G. Gutkind,et al.  Changing Epidemiology of KPC Producing Klebsiella pneumoniae in Argentina: Emergence of Hypermucoviscous ST25 and High Risk Clone ST307. , 2019, Journal of global antimicrobial resistance.

[10]  Baotao Liu,et al.  Whole genome sequencing of NDM-1-producing serotype K1 ST23 hypervirulent Klebsiella pneumoniae in China. , 2019, Journal of medical microbiology.

[11]  K. Tateda,et al.  Emergence of IMP-producing hypervirulent Klebsiella pneumoniae carrying a pLVPK-like virulence plasmid. , 2019, International journal of antimicrobial agents.

[12]  Wei Zhang,et al.  Whole genome assembly and functional portrait of hypervirulent extensively drug-resistant NDM-1 and KPC-2 co-producing Klebsiella pneumoniae of capsular serotype K2 and ST86 , 2019, The Journal of antimicrobial chemotherapy.

[13]  Lanjuan Li,et al.  High prevalence of KPC-2-producing hypervirulent Klebsiella pneumoniae causing meningitis in Eastern China , 2019, Infection and drug resistance.

[14]  P. Gastmeier,et al.  Plasmid-Mediated Transmission of KPC-2 Carbapenemase in Enterobacteriaceae in Critically Ill Patients , 2019, Front. Microbiol..

[15]  K. Holt,et al.  Convergence of virulence and MDR in a single plasmid vector in MDR Klebsiella pneumoniae ST15 , 2019, The Journal of antimicrobial chemotherapy.

[16]  Xiuli Zhang,et al.  Emergence of a Multidrug-Resistant Hypervirulent Klebsiella pneumoniae Sequence Type 23 Strain with a Rare blaCTX-M-24-Harboring Virulence Plasmid , 2019, Antimicrobial Agents and Chemotherapy.

[17]  Jianying Zhou,et al.  Virulence and genomic features of a blaCTX-M-3 and blaCTX-M-14 coharboring hypermucoviscous Klebsiella pneumoniae of serotype K2 and ST65 , 2019, Infection and drug resistance.

[18]  Y. Ye,et al.  Identification and Characterization of NDM-1-producing Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae in China , 2018, Annals of laboratory medicine.

[19]  Hongwei Zhou,et al.  Emergence of OXA-232 Carbapenemase-Producing Klebsiella pneumoniae That Carries a pLVPK-Like Virulence Plasmid among Elderly Patients in China , 2018, Antimicrobial Agents and Chemotherapy.

[20]  Yi-qi Fu,et al.  Endogenous endophthalmitis caused by a multidrug-resistant hypervirulent Klebsiella pneumoniae strain belonging to a novel single locus variant of ST23: first case report in China , 2018, BMC Infectious Diseases.

[21]  F. Shahcheraghi,et al.  Outbreak of hypervirulent Klebsiella pneumoniae harbouring blaVIM-2 among mechanically-ventilated drug-poisoning patients with high mortality rate in Iran. , 2018, Journal of global antimicrobial resistance.

[22]  Z. Zong,et al.  The Occurence of Colistin-Resistant Hypervirulent Klebsiella pneumoniae in China , 2018, Front. Microbiol..

[23]  Rong Zhang,et al.  Carriage of blaKPC-2 by a virulence plasmid in hypervirulent Klebsiella pneumoniae , 2018, The Journal of antimicrobial chemotherapy.

[24]  S. Sørensen,et al.  Monitoring plasmid-mediated horizontal gene transfer in microbiomes: recent advances and future perspectives. , 2018, Plasmid.

[25]  Rong Zhang,et al.  Tracking microevolution events among ST11 carbapenemase-producing hypervirulent Klebsiella pneumoniae outbreak strains , 2018, Emerging Microbes & Infections.

[26]  Yi-Wei Huang,et al.  High mortality among patients infected with hypervirulent antimicrobial-resistant capsular type K1 Klebsiella pneumoniae strains in Taiwan. , 2018, International journal of antimicrobial agents.

[27]  Yen‐Hua Huang,et al.  Emergence of an XDR and carbapenemase-producing hypervirulent Klebsiella pneumoniae strain in Taiwan , 2018, The Journal of antimicrobial chemotherapy.

[28]  I. Gordo,et al.  Evolutionary Mechanisms Shaping the Maintenance of Antibiotic Resistance. , 2018, Trends in microbiology.

[29]  K. Holt,et al.  Tracking key virulence loci encoding aerobactin and salmochelin siderophore synthesis in Klebsiella pneumoniae , 2018, Genome Medicine.

[30]  D. Gu,et al.  Emergence of tet(A) and blaKPC-2 co-carrying plasmid from a ST11 hypervirulent Klebsiella pneumoniae isolate in patient's gut. , 2018, International journal of antimicrobial agents.

[31]  K. Hopkins,et al.  A case of NDM-carbapenemase-producing hypervirulent Klebsiella pneumoniae sequence type 23 from the UK , 2018, JMM case reports.

[32]  Z. Zong,et al.  Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae of Sequence Type 36 , 2018, Antimicrobial Agents and Chemotherapy.

[33]  Z. Deng,et al.  Emergence of the third-generation cephalosporin-resistant hypervirulent Klebsiella pneumoniae due to the acquisition of a self-transferable blaDHA-1-carrying plasmid by an ST23 strain , 2018, Virulence.

[34]  Yang Liu,et al.  Draft Genome Sequence of an NDM-1- and KPC-2-Coproducing Hypervirulent Carbapenem-Resistant Klebsiella pneumoniae Strain Isolated from Burn Wound Infections , 2018, Genome Announcements.

[35]  Jianzhong Shen,et al.  Emergence of carbapenem-resistant hypervirulent Klebsiella pneumoniae. , 2017, The Lancet. Infectious diseases.

[36]  K. Yuen,et al.  Emergence of carbapenem-resistant hypervirulent Klebsiella pneumoniae. , 2018, The Lancet. Infectious diseases.

[37]  N. Woodford,et al.  Virulence genes in isolates of Klebsiella pneumoniae from the UK during 2016, including among carbapenemase gene‐positive hypervirulent K1‐ST23 and ‘non‐hypervirulent’ types ST147, ST15 and ST383 , 2018, Journal of medical microbiology.

[38]  Chen Chen,et al.  Emergence of carbapenem-resistant hypervirulent Klebsiella pneumoniae. , 2018, The Lancet. Infectious diseases.

[39]  D. Gu,et al.  A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study. , 2018, The Lancet. Infectious diseases.

[40]  Young Bae Kim,et al.  Antimicrobial Resistance of Hypervirulent Klebsiella pneumoniae: Epidemiology, Hypervirulence-Associated Determinants, and Resistance Mechanisms , 2017, Front. Cell. Infect. Microbiol..

[41]  N. Firth,et al.  Diverse mobilization strategies facilitate transfer of non-conjugative mobile genetic elements. , 2017, Current opinion in microbiology.

[42]  Liangxing Wang,et al.  Outbreak by Hypermucoviscous Klebsiella pneumoniae ST11 Isolates with Carbapenem Resistance in a Tertiary Hospital in China , 2017, Front. Cell. Infect. Microbiol..

[43]  U. Garza-Ramos,et al.  Hypervirulence and hypermucoviscosity: Two different but complementary Klebsiella spp. phenotypes? , 2017, Virulence.

[44]  Alessandra Carattoli,et al.  Klebsiella pneumoniae: a major worldwide source and shuttle for antibiotic resistance , 2017, FEMS microbiology reviews.

[45]  S. Bradley.  Whole Genome Sequence , 2017 .

[46]  V. di Pilato,et al.  Infections caused by carbapenem-resistant Klebsiella pneumoniae with hypermucoviscous phenotype: A case report and literature review , 2017, Virulence.

[47]  George Priya Doss C,et al.  Draft Genome Sequences of Three Hypervirulent Carbapenem-Resistant Klebsiella pneumoniae Isolates from Bacteremia , 2016, Genome Announcements.

[48]  Yonghong Xiao,et al.  High Prevalence of ESBL-Producing Klebsiella pneumoniae Causing Community-Onset Infections in China , 2016, Frontiers in microbiology.

[49]  B. Veeraraghavan,et al.  Draft Genome Sequence of an Extended-Spectrum-β-Lactamase-Positive Hypervirulent Klebsiella pneumoniae Strain with Novel Sequence Type 2318 Isolated from a Neonate , 2016, Genome Announcements.

[50]  A. Boyd,et al.  ESBL-Producing Strain of Hypervirulent Klebsiella pneumoniae K2, France , 2016, Emerging infectious diseases.

[51]  Ruobing Wang,et al.  High Prevalence of Hypervirulent Klebsiella pneumoniae Infection in China: Geographic Distribution, Clinical Characteristics, and Antimicrobial Resistance , 2016, Antimicrobial Agents and Chemotherapy.

[52]  Young Bae Kim,et al.  Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods , 2016, Front. Microbiol..

[53]  D. Gu,et al.  Detection of Colistin Resistance Gene mcr-1 in Hypervirulent Klebsiella pneumoniae and Escherichia coli Isolates from an Infant with Diarrhea in China , 2016, Antimicrobial Agents and Chemotherapy.

[54]  Yang Liu,et al.  Emergence of KPC-producing Klebsiella pneumoniae hypervirulent clone of capsular serotype K1 that belongs to sequence type 11 in Mainland China. , 2016, Diagnostic microbiology and infectious disease.

[55]  Yang Liu,et al.  Draft Genome Sequence of an NDM-5-Producing Klebsiella pneumoniae Sequence Type 14 Strain of Serotype K2 , 2016, Genome Announcements.

[56]  F. Tubau,et al.  Hypervirulent Klebsiella pneumoniae clones causing bacteraemia in adults in a teaching hospital in Barcelona, Spain (2007-2013). , 2016, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[57]  R. Vaidyanathan,et al.  Whole genome sequence of Klebsiella pneumoniae U25, a hypermucoviscous, multidrug resistant, biofilm producing isolate from India , 2016, Memorias do Instituto Oswaldo Cruz.

[58]  D. Gu,et al.  Emergence of Carbapenem-Resistant Serotype K1 Hypervirulent Klebsiella pneumoniae Strains in China , 2015, Antimicrobial Agents and Chemotherapy.

[59]  B. Cao,et al.  Emergence of a hypervirulent carbapenem-resistant Klebsiella pneumoniae isolate from clinical infections in China. , 2015, The Journal of infection.

[60]  Xiumei Xiao,et al.  Clinical and molecular characteristics of multi-clone carbapenem-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in a tertiary hospital in Beijing, China. , 2015, International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases.

[61]  S. Brisse,et al.  Genomic Definition of Hypervirulent and Multidrug-Resistant Klebsiella pneumoniae Clonal Groups , 2014, Emerging infectious diseases.

[62]  S. Million-Weaver,et al.  Mechanisms of plasmid segregation: have multicopy plasmids been overlooked? , 2014, Plasmid.

[63]  L. Fernández Canigia,et al.  First Isolate of KPC-2-Producing Klebsiella pneumonaie Sequence Type 23 from the Americas , 2014, Journal of Clinical Microbiology.

[64]  L. N. Andrade,et al.  Expansion and Evolution of a Virulent, Extensively Drug-Resistant (Polymyxin B-Resistant), QnrS1-, CTX-M-2-, and KPC-2-Producing Klebsiella pneumoniae ST11 International High-Risk Clone , 2014, Journal of Clinical Microbiology.

[65]  H. Maltezou,et al.  Infections caused by carbapenem-resistant Klebsiella pneumoniae among patients in intensive care units in Greece: a multi-centre study on clinical outcome and therapeutic options. , 2014, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases.

[66]  Ning Li,et al.  Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China. , 2014, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[67]  T. Russo,et al.  Hypervirulent (hypermucoviscous) Klebsiella pneumoniae , 2013, Virulence.

[68]  G. Daikos,et al.  Carbapenemases in Klebsiella pneumoniae and Other Enterobacteriaceae: an Evolving Crisis of Global Dimensions , 2012, Clinical Microbiology Reviews.

[69]  Fernando de la Cruz,et al.  Mobility of Plasmids , 2010, Microbiology and Molecular Biology Reviews.

[70]  Laura S. Frost,et al.  Mobile genetic elements: the agents of open source evolution , 2005, Nature Reviews Microbiology.

[71]  in a Fatal , 2022 .