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Chasing the landscape for intrahospital transmission and evolution of hypervirulent carbapenem-resistant Klebsiella pneumoniae

文献类型： 外文期刊

作者： Liu, Lizhang 1 ; Lou, Ningjie 1 ; Liang, Qiqiang 1 ; Xiao, Wei 1 ; Teng, Gaoqin 1 ; Ma, Jiangang 4 ; Zhang, Huimin 5 ; Huang, Man 1 ; Feng, Youjun 1 ;

作者机构： 1.Zhejiang Univ, Sch Med, Key Lab Multiple Organ Failure, Minist Educ, Hangzhou 310058, Peoples R China

2.Zhejiang Univ, Affiliated Hosp 2, Sch Med, Dept Microbiol, Hangzhou 310058, Peoples R China

3.Zhejiang Univ, Sch Med, Affiliated Hosp 2, Gen Intens Care Unit, Hangzhou 310058, Peoples R China

4.Zhejiang Acad Agr Sci, Hangzhou 310021, Peoples R China

5.Univ Illinois, Canc Ctr Illinois, Urbana, IL 61801 USA

6.Southern Univ Sci & Technol, Shenzhen Peoples Hosp 3, Natl Clin Res Ctr Infect Dis, Dept Clin Lab,Affiliated Hosp 2, Shenzhen 518112, Peoples R China

7.Zhejiang Prov Key Lab Microbial Biochem & Metab En, Hangzhou 310058, Peoples R China

关键词： Carbapenem-resistant Klebsiella pneumoniae; Hypervirulent CRKP; ST11-K64; Intrahospital evolution; Fusion plasmid; rmpA promoter

期刊名称：SCIENCE BULLETIN （ 影响因子：18.9； 五年影响因子：14.2 ）

ISSN： 2095-9273

年卷期： 2023 年 68 卷 23 期

页码：

收录情况： SCI

摘要： The spread of hypervirulent carbapenem-resistant Klebsiella pneumoniae (Hv-CRKP) is a global health concern. Here, we report the intrahospital colonization and spread of Hv-CRKP isolates in a tertiary hospital from 2017 to 2022. Analyses of 90 nonredundant CRKP isolates from 72 patients indicated that Hv-CRKP transferability relies on the dominant ST11-K64 clone. Whole-genome sequencing of 11 representative isolates gave 31 complete plasmid sequences, including 12 KPC-2 resistance carriers and 10 RmpA virulence vehicles. Apart from the binary vehicles, we detected two types of fusion plasmids, favoring the cotransfer of RmpA virulence and KPC-2 resistance. The detection of ancestry/relic plasmids enabled us to establish genetic mechanisms by which rare fusion plasmids form. Unexpectedly, we found a total of five rmpA promoter variants (P9T-P13T) exhibiting distinct activities and varying markedly in their geographic distributions. CRISPR/Cas9 manipulation confirmed that an active PT11-rmpA regulator is a biomarker for the "high-risk" ST11-K64/CRKP clone. These findings suggest clonal spread and clinical evolution of the prevalent ST11-K64/Hv-CRKP clones. Apart from improved public awareness of Hv-CRKP convergence, our findings might benefit the development of surveillance (and/or intervention) strategies for the dominant ST11-K64 lineage of the Hv-CRKP population in healthcare sectors.(c) 2023 Science China Press. Published by Elsevier B.V. and Science China Press. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

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