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Hypervirulent Klebsiella pneumoniae is emerging as an increasingly prevalent K. pneumoniae pathotype responsible for nosocomial and healthcare-associated infections in Beijing, China

Authors
  • Liu, Chao1
  • Du, Pengcheng2
  • Xiao, Nan3
  • Ji, Fansen4
  • Russo, Thomas A.5, 6
  • Guo, Jun7
  • 1 Peking University Third Hospital, China , (China)
  • 2 Institute of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, and Beijing Key Laboratory of Emerging Infectious Diseases, China , (China)
  • 3 Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, China , (China)
  • 4 School of Medicine, Tsinghua University, China , (China)
  • 5 University at Buffalo, State University of New York, USA
  • 6 Veterans Administration Western New York Healthcare System, USA
  • 7 School of Clinical Medicine, Tsinghua University, China , (China)
Type
Published Article
Journal
Virulence
Publisher
Landes Bioscience
Publication Date
Sep 12, 2020
Volume
11
Issue
1
Pages
1215–1224
Identifiers
DOI: 10.1080/21505594.2020.1809322
PMID: 32921250
PMCID: PMC7549996
Source
PubMed Central
Keywords
License
Green

Abstract

Objectives Hypervirulent Klebsiella pneumoniae(hvKp) is an increasingly important pathogen. Tracking its epidemiology and evolving antimicrobial resistance will facilitate care. Methods A retrospective study was conducted in two hospitals. We collected the clinical data. Antimicrobial and virulence-associated phenotype and genotype, sequence type, and whole genome sequencing of selected strains were performed. HvKp was defined by the presence of some combination of prmpA, prmpA2, iucA, iroB, and peg-344, genes shown to accurately identify hvKp. Results Of 158 Kp clinical isolates, 79 (50%) were hvKp. Interestingly, 53/79 (67.1%) of hvKp strains were isolated from patients with nosocomial infection and 19/79 (24.1%) from patients with healthcare-associated infection, but only 7/79 (8.8%) from patients with community-acquired infections. Importantly, 27/53 (50.9%) and 4/19 (21.1%) of hvKp nosocomial and healthcare-associated isolates, respectively, were multi-drug-resistant (MDR); 25/53 (47.2%) and 5/19 (26.3%) expressed ESBLs and 14/53 (26.4%) and 2/19 (10.5%) were carbapenem-resistant. Of the hvKp isolates from community-acquired infection, 0/7 (0%) were MDR and 0/7 (0%) were carbapenem-resistant. Additionally, unique characteristics of nosocomial, healthcare-associated, and community-acquired hvKp infection were identified. In summary, 50% of K. pneumoniae infections were caused by hvKp. A concerning, novel finding from this report is a major shift in hvKp epidemiology. Ninety-one percent of hvKp infections were nosocomial or healthcare-associated, and 43.1% of these isolates were MDR. Conclusions These data suggest that hvKp may be replacing classical K. pneumoniae as the dominant nosocomial and healthcare-associated pathotype. Ongoing surveillance is needed to determine if this trend is occurring elsewhere.

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