The Epidemiology, Virulence and Antimicrobial Resistance of Invasive Klebsiella pneumoniae at a Children's Medical Center in Eastern China

doi:10.2147/IDR.S323353

. 2021 Sep 14:14:3737-3752.

doi: 10.2147/IDR.S323353. eCollection 2021.

The Epidemiology, Virulence and Antimicrobial Resistance of Invasive Klebsiella pneumoniae at a Children's Medical Center in Eastern China

Yang Li^#^{1

2

3

4}, Dan Li^#⁵, Jian Xue⁴, Xueqiang Ji⁴, Xuejun Shao⁴, Jie Yan^{1

2

3}

Affiliations

¹ Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China.
² Department of Medical Microbiology and Parasitology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310058, People's Republic of China.
³ Division of Basic Medical Microbiology, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China.
⁴ Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China.
⁵ Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, People's Republic of China.

^# Contributed equally.

PMID: 34548798
PMCID: PMC8449645
DOI: 10.2147/IDR.S323353

Free PMC article

The Epidemiology, Virulence and Antimicrobial Resistance of Invasive Klebsiella pneumoniae at a Children's Medical Center in Eastern China

Yang Li et al. Infect Drug Resist. 2021.

Free PMC article

. 2021 Sep 14:14:3737-3752.

doi: 10.2147/IDR.S323353. eCollection 2021.

Authors

Yang Li^#^{1

2

3

4}, Dan Li^#⁵, Jian Xue⁴, Xueqiang Ji⁴, Xuejun Shao⁴, Jie Yan^{1

2

3}

Affiliations

¹ Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China.
² Department of Medical Microbiology and Parasitology, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310058, People's Republic of China.
³ Division of Basic Medical Microbiology, State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310003, People's Republic of China.
⁴ Department of Clinical Laboratory, Children's Hospital of Soochow University, Suzhou, Jiangsu, 215025, People's Republic of China.
⁵ Department of Clinical Laboratory, The Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215004, People's Republic of China.

^# Contributed equally.

PMID: 34548798
PMCID: PMC8449645
DOI: 10.2147/IDR.S323353

Abstract

Objective: This study investigated the epidemiology, virulence and drug resistance of invasive Klebsiella pneumoniae (K. pneumoniae) isolates at a children's medical center in eastern China in order to obtain epidemiologic, virulence, and antimicrobial resistance data that can guide for the selection and development of anti-infection treatments.

Methods: A total of 94 invasive K. pneumoniae strains were isolated from children between January 2016 and December 2020 at the Children's Hospital of Soochow University. The strains were identified by mass spectrometry. The Kirby-Bauer method and VITEK 2 Compact system were used to analyze the antimicrobial susceptibility. Polymerase chain reaction (PCR) and sequencing was performed to detect the capsular serotypes, virulence-associated genes, β-lactam antibiotic resistance genes and multilocus sequence typing.

Results: The PCR results showed that 87 strains (92.55%) of invasive K. pneumoniae were hypervirulent capsular serotypes, with K57 as the dominant capsular serotype (62.77%). All strains carried virulence-associated genes. Among them, 84 strains (89.36%) carried hypervirulence genes, with iroB (86.17%) being the predominant; meanwhile, other virulence genes, including wabG (100.00%), mrkD (98.94%), ycfM (96.81%), fimH (95.74%) and Uge (88.30%), were detected in most strains. All strains carried β-lactam antibiotic resistance genes; the main extended-spectrum β-lactamase gene was bla _SHV-11 (86.17%) and the major AmpC cephalosporinase genes were bla _FOX-1 (86.17%) and bla _ACT-1 (70.21%). Carbapenemase genes were detected in only a few isolates. Notably, 12 invasive K. pneumoniae isolates were identified as carbapenem-resistant and hypervirulent K. pneumoniae (CR-HVKP), and 14 other multidrug resistance (MDR) isolates were also detected.

Conclusion: The results of this study reveal the epidemiology, virulence and antimicrobial resistance of invasive K. pneumoniae in pediatric patients. Both CR-HVKP and MDR strains were identified, which should be of great concern to clinicians.

Keywords: Klebsiella pneumoniae; children; invasive infection; resistance genes; virulence factors.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

Figures

**Figure 1**
The first isolated samples of invasive *K. pneumoniae* strains in this study.

**Figure 2**
The annual trends of invasive *K. pneumoniae* cases by clinical diagnosis from 2016 to 2020 in this study.

**Figure 3**
The heat-map of capsular serotypes and virulence-associated genes of invasive *K. pneumoniae* strains in this study.

**Figure 4**
The heat-map of the different degrees of antimicrobial resistance of invasive *K. pneumoniae* strains in this study.

**Figure 5**
The heat-map of β-lactam antibiotic genes of invasive *K. pneumoniae* strains in this study.

See this image and copyright information in PMC

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[1] Viau RA, Hujer AM, Marshall SH, et al. “Silent” dissemination of Klebsiella pneumoniae isolates bearing K. pneumoniae carbapenemase in a long-term care facility for children and young adults in Northeast Ohio. Clin Infect Dis. 2012;54(9):1314–1321. doi:10.1093/cid/cis036 - DOI - PMC - PubMed

[2] Viau RA, Hujer AM, Marshall SH, et al. “Silent” dissemination of Klebsiella pneumoniae isolates bearing K. pneumoniae carbapenemase in a long-term care facility for children and young adults in Northeast Ohio. Clin Infect Dis. 2012;54(9):1314–1321. doi:10.1093/cid/cis036 - DOI - PMC - PubMed

[3] Martin RM, Bachman MA. Colonization, infection, and the accessory genome of Klebsiella pneumoniae. Front Cell Infect Microbiol. 2018;8:4. doi:10.3389/fcimb.2018.00004 - DOI - PMC - PubMed

[4] Martin RM, Bachman MA. Colonization, infection, and the accessory genome of Klebsiella pneumoniae. Front Cell Infect Microbiol. 2018;8:4. doi:10.3389/fcimb.2018.00004 - DOI - PMC - PubMed

[5] Bengoechea JA, Sa Pessoa J. Klebsiella pneumoniae infection biology: living to counteract host defences. FEMS Microbiol Rev. 2019;43(2):123–144. doi:10.1093/femsre/fuy043 - DOI - PMC - PubMed

[6] Bengoechea JA, Sa Pessoa J. Klebsiella pneumoniae infection biology: living to counteract host defences. FEMS Microbiol Rev. 2019;43(2):123–144. doi:10.1093/femsre/fuy043 - DOI - PMC - PubMed

[7] Russo TA, Marr CM. Hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev. 2019;32(3):e00001–19. doi:10.1128/CMR.00001-19 - DOI - PMC - PubMed

[8] Russo TA, Marr CM. Hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev. 2019;32(3):e00001–19. doi:10.1128/CMR.00001-19 - DOI - PMC - PubMed

[9] Cubero M, Grau I, Tubau F, et al. Hypervirulent Klebsiella pneumoniae clones causing bacteraemia in adults in a teaching hospital in Barcelona, Spain (2007–2013). Clin Microbiol Infect. 2016;22(2):154–160. doi:10.1016/j.cmi.2015.09.025 - DOI - PubMed

[10] Cubero M, Grau I, Tubau F, et al. Hypervirulent Klebsiella pneumoniae clones causing bacteraemia in adults in a teaching hospital in Barcelona, Spain (2007–2013). Clin Microbiol Infect. 2016;22(2):154–160. doi:10.1016/j.cmi.2015.09.025 - DOI - PubMed

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The Epidemiology, Virulence and Antimicrobial Resistance of Invasive Klebsiella pneumoniae at a Children's Medical Center in Eastern China

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The Epidemiology, Virulence and Antimicrobial Resistance of Invasive Klebsiella pneumoniae at a Children's Medical Center in Eastern China

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