Emergence of ST11-K47 and ST11-K64 hypervirulent carbapenem-resistant Klebsiella pneumoniae in bacterial liver abscesses from China: a molecular, biological, and epidemiological study

Qiwen Yang; Xinmiao Jia; Menglan Zhou; Hui Zhang; Wenhang Yang; Timothy Kudinha; Yingchun Xu

doi:10.1080/22221751.2020.1721334

Emergence of ST11-K47 and ST11-K64 hypervirulent carbapenem-resistant Klebsiella pneumoniae in bacterial liver abscesses from China: a molecular, biological, and epidemiological study

Emerg Microbes Infect. 2020 Feb 9;9(1):320-331. doi: 10.1080/22221751.2020.1721334. eCollection 2020.

Authors

Qiwen Yang^{1

2}, Xinmiao Jia³, Menglan Zhou^{1

2

4}, Hui Zhang^{1

2}, Wenhang Yang^{1

2}, Timothy Kudinha^{5

6}, Yingchun Xu^{1

2}

Affiliations

¹ Department of Clinical Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
² Beijing Key Laboratory for Mechanisms Research and Precision Diagnosis of Invasive Fungal Diseases, Beijing, People's Republic of China.
³ Central Research Laboratory, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
⁴ Graduate School, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, People's Republic of China.
⁵ School of Biomedical Sciences, Charles Sturt University, Orange, Australia.
⁶ Pathology West, NSW Health Pathology, Orange, Australia.

Abstract

Background: Multidrug-resistant bacteria, especially those with high virulence, are an emerging problem in clinical settings.Methods: We conducted a multicentre epidemiological and comparative genomic analysis on the evolution, virulence and antimicrobial resistance of carbapenem-resistant Enterobacteriaceae in patients with bacterial liver abscesses from 2012 to 2016.Results: A total of 477 bacterial isolates were collected. Enterobacteriaceae were the main pathogen (89.3%) with K. pneumoniae (52.4%) predominating followed by Escherichia coli (26.8%). All CRKps (3.2%) were of sequence type (ST) 11 and serotypes K47 or K64, and simultaneously possessed acquired bla_KPC-2/bla_KPC-5 and bla_CTX-M-65 together with the multidrug transporter EmrE. Seven Hv-CRKps (five ST11-K47, two ST11-K64) were confirmed by bacteriological test, neutrophil killing assay and Galleria mellonella infection model. Genomic analysis indicated that the emergence of one ST11-K64 Hv-CRKp strain was related to the acquisition of rmpA/rmpA2 genes and siderophore gene clusters, while ST11-K47 Hv-CRKp lacked these traditional virulence genes. Further complete genome analysis of one ST11-K47 Hv-CRKp strain, R16, showed that it acquired a rare plasmid (pR16-Hv-CRKp1) carrying bla_KPC-2, bla_SHV-12, bla_TEM-1, bla_CTX-M-65, rmtB and a predicted virulence gene R16_5486 simultaneously.Conclusion: The emergence of the ST11-K47/K64 Hv-CRKps, which are simultaneously multidrug-resistant and hypervirulent, requires urgent control measures to be implemented.

Keywords: Hypervirulent; Klebsiella pneumoniae; bacterial liver abscesses; carbapenem-resistant.

Publication types

Multicenter Study

MeSH terms

Aged
Bacterial Typing Techniques
Carbapenem-Resistant Enterobacteriaceae / classification
Carbapenem-Resistant Enterobacteriaceae / isolation & purification*
China
Drug Resistance, Multiple, Bacterial
Female
Humans
Klebsiella Infections / microbiology*
Klebsiella pneumoniae / classification
Klebsiella pneumoniae / isolation & purification*
Liver Abscess / microbiology*
Male
Microbial Sensitivity Tests
Middle Aged
Multilocus Sequence Typing
Plasmids / genetics
Serogroup
Virulence

Grants and funding

This work was supported by the National Key Research and Development Program of China (2018YFC1200100, 2018YFC1200105), Chinese Academy of Medical Sciences (CAMS) Initiative for Innovative Medicine (grant number 2016-I2M-3–014), Graduate Innovation Fund of Peking Union Medical College (grant number 2017–1002-1–21).