Risk factors and clinical impact associated with infections caused by different types of carbapenem-resistant Klebsiella pneumoniae in China: A clinical study from 2014 to 2017

doi:10.1016/j.jinf.2022.05.045

Journal of Infection

Volume 85, Issue 4, October 2022, Pages 436-480

https://doi.org/10.1016/j.jinf.2022.05.045 Get rights and content

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Contributors

QLS, YLH, YL and JPL collected the strains, performed strain characterization and collected clinical data; XMY helped with strain characterization and clinical data analysis; HDH and CCL helped with data analysis; RZ and SC designed and supervised the study, and interpreted the data; SC wrote the manuscript.

Declaration of Competing Interest

We declare that we have no conflicts of interest.

Acknowledgments

The research was supported by Guangdong Major Project of Basic and Applied Basic Research (2020B0301030005) and NSFC/RGC grant (NSFC-RGC, N_PolyU521/18) from the National Natural Science Fund in China and Research Grant Council of the Government of Hong Kong SAR, and the National Natural Science Foundation of China (82102451 and 22193064).

References (4)

D. Gu et al.
A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study
Lancet Infect Dis
(2018)
T. Lou et al.
Risk factors for infection and mortality caused by carbapenem-resistant Klebsiella pneumoniae: a large multicentre case–control and cohort study
J Infect
(2022)

There are more references available in the full text version of this article.

Cited by (2)

Opposite evolution of pathogenicity driven by in vivo wzc and wcaJ mutations in ST11-KL64 carbapenem-resistant Klebsiella pneumoniae
2023, Drug Resistance Updates
Citation Excerpt :
Zhang et al. (2020) reported that hypermucoid phenotype was observed only in six (8.3%) of 72 CRKP isolates containing rmpA and rmpA2 collected from municipalities across China between 2015 and 2017. Sun et al. (2022) reported that only 14% CR-hvKP that harbored the pLVPK-like plasmid were positive for string test and only the CR-HvKP strains with a hypermucoid phenotype were associated with increased mortality. Palacios et al. (2018) reported that two regulators of cps expression, KvrA and KvrB are found in both cKP and hvKP strains, but they only regulate capsule synthesis in the hv strains.
To investigate the in vivo evolution of the mucoid-phenotype of ST11-KL64 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolated from the same patients and gain insights into diverse evolution and biology of these strains.
Whole genome sequencing and bioinformatic analysis were used to determine the mutation involved in the mucoid phenotype of ST11-KL64 CRKP. Gene knockout, bacterial morphology and capsular polysaccharides (CPS) extraction were used to verify the role of wzc and wcaJ in the mucoid phenotypes. Antimicrobial susceptibility, growth assay, biofilm formation, host cell adhesion and virulence assay were used to investigate the pleiotropic role of CPS changes in ST11-KL64 CRKP strains.
Mutation of wzc S682N led to hypermucoid phenotype, which had negative impact on bacterial fitness and resulted in reduced biofilm formation and epithelial cell adhesion; while enhanced resistance to macrophage phagocytosis and virulence. Mutations of wcaJ gene led to non-mucoid phenotype with increased biofilm formation and epithelial cell adhesion, but reduced resistance of macrophage phagocytosis and virulence. Using virulence gene knockout, we demonstrated that CPS, rather than the pLVPK-like virulence plasmid, has a greater effect on mucoid phenotypic changes. CPS could be used as a surrogate marker of virulence in ST11-KL64 CRKP strains.
ST11-KL64 CRKP strains sacrifice certain advantages to develop pathogenicity by changing CPS with two opposite in vivo evolution strategies.
Clinical use of tigecycline may contribute to the widespread dissemination of carbapenem-resistant hypervirulent Klebsiella pneumoniae strains
2024, Emerging Microbes and Infections

¹: These authors contributed equally to the work.

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Letter to the EditorRisk factors and clinical impact associated with infections caused by different types of carbapenem-resistant Klebsiella pneumoniae in China: A clinical study from 2014 to 2017

Section snippets

Contributors

Declaration of Competing Interest

Acknowledgments

Lancet Infect Dis

Risk factors for infection and mortality caused by carbapenem-resistant Klebsiella pneumoniae: a large multicentre case–control and cohort study

J Infect

Letter to the Editor
Risk factors and clinical impact associated with infections caused by different types of carbapenem-resistant Klebsiella pneumoniae in China: A clinical study from 2014 to 2017