An Outbreak of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Wenzhou, China

Yajie Zhao, Xiucai Zhang, Von Vergel L. Torres, Haiyang Liu, Andrea Rocker, Yizhi Zhang, Jiawei Wang, Lijiang Chen, Wenzi Bi, Jie Lin, Richard A. Strugnell, Siqin Zhang, Trevor Lithgow, Tieli Zhou, Jianming Cao

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Carbapenem-resistant, hypervirulent Klebsiella pneumoniae (CR-hvKP) has recently emerged as a significant threat to public health. In this study, 29 K. pneumoniae isolates were isolated from eight patients admitted to the intensive care unit (ICU) of a comprehensive teaching hospital located in China from March 2017 to January 2018. Clinical information of patients was the basis for the further analyses of the isolates including antimicrobial susceptibility tests, identification of antibiotic resistance and virulence gene determinants, multilocus sequence typing (MLST), XbaI-macrorestriction by pulsed-field gel electrophoresis (PFGE). Selected isolates representing distinct resistance profiles and virulence phenotypes were screened for hypervirulence in a Galleria mellonella larvae infection model. In the course of the outbreak, the overall mortality rate of patients was 100% (n = 8) attributed to complications arising from CR-hvKP infections. All isolates except one (28/29, 96.6%) were resistant to multiple antimicrobial agents, and harbored diverse resistance determinants that included the globally prevalent carbapenemase blaKPC−2. Most isolates had hypervirulent genotypes being positive for 19 virulence-associated genes, including iutA (25/29, 86.2%), rmpA (27/29, 93.1%), ybtA (27/29, 93.1%), entB (29/29, 100%), fimH (29/29, 100%), and mrkD (29/29, 100%). MLST revealed ST11 for the majority of isolates (26/29, 89,7%). Infection assays demonstrated high mortality in the Galleria mellonella model with the highest LD50 values for three isolates (<105 CFU/mL) demonstrating the degree of hypervirulence of these CR-hvKP isolates, and is discussed relative to previous outbreaks of CR-hvKP.

Original languageEnglish
Article number229
Number of pages11
JournalFrontiers in Public Health
Volume7
DOIs
Publication statusPublished - 19 Aug 2019

Keywords

  • carbapenem-resistance
  • epidemiology
  • hypervirulent
  • Klebsiella pneumoniae
  • ST11

Cite this

Zhao, Yajie ; Zhang, Xiucai ; Torres, Von Vergel L. ; Liu, Haiyang ; Rocker, Andrea ; Zhang, Yizhi ; Wang, Jiawei ; Chen, Lijiang ; Bi, Wenzi ; Lin, Jie ; Strugnell, Richard A. ; Zhang, Siqin ; Lithgow, Trevor ; Zhou, Tieli ; Cao, Jianming. / An Outbreak of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Wenzhou, China. In: Frontiers in Public Health. 2019 ; Vol. 7.
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title = "An Outbreak of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Wenzhou, China",
abstract = "Carbapenem-resistant, hypervirulent Klebsiella pneumoniae (CR-hvKP) has recently emerged as a significant threat to public health. In this study, 29 K. pneumoniae isolates were isolated from eight patients admitted to the intensive care unit (ICU) of a comprehensive teaching hospital located in China from March 2017 to January 2018. Clinical information of patients was the basis for the further analyses of the isolates including antimicrobial susceptibility tests, identification of antibiotic resistance and virulence gene determinants, multilocus sequence typing (MLST), XbaI-macrorestriction by pulsed-field gel electrophoresis (PFGE). Selected isolates representing distinct resistance profiles and virulence phenotypes were screened for hypervirulence in a Galleria mellonella larvae infection model. In the course of the outbreak, the overall mortality rate of patients was 100{\%} (n = 8) attributed to complications arising from CR-hvKP infections. All isolates except one (28/29, 96.6{\%}) were resistant to multiple antimicrobial agents, and harbored diverse resistance determinants that included the globally prevalent carbapenemase blaKPC−2. Most isolates had hypervirulent genotypes being positive for 19 virulence-associated genes, including iutA (25/29, 86.2{\%}), rmpA (27/29, 93.1{\%}), ybtA (27/29, 93.1{\%}), entB (29/29, 100{\%}), fimH (29/29, 100{\%}), and mrkD (29/29, 100{\%}). MLST revealed ST11 for the majority of isolates (26/29, 89,7{\%}). Infection assays demonstrated high mortality in the Galleria mellonella model with the highest LD50 values for three isolates (<105 CFU/mL) demonstrating the degree of hypervirulence of these CR-hvKP isolates, and is discussed relative to previous outbreaks of CR-hvKP.",
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author = "Yajie Zhao and Xiucai Zhang and Torres, {Von Vergel L.} and Haiyang Liu and Andrea Rocker and Yizhi Zhang and Jiawei Wang and Lijiang Chen and Wenzi Bi and Jie Lin and Strugnell, {Richard A.} and Siqin Zhang and Trevor Lithgow and Tieli Zhou and Jianming Cao",
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An Outbreak of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Wenzhou, China. / Zhao, Yajie; Zhang, Xiucai; Torres, Von Vergel L.; Liu, Haiyang; Rocker, Andrea; Zhang, Yizhi; Wang, Jiawei; Chen, Lijiang; Bi, Wenzi; Lin, Jie; Strugnell, Richard A.; Zhang, Siqin; Lithgow, Trevor; Zhou, Tieli; Cao, Jianming.

In: Frontiers in Public Health, Vol. 7, 229, 19.08.2019.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Zhang, Xiucai

AU - Torres, Von Vergel L.

AU - Liu, Haiyang

AU - Rocker, Andrea

AU - Zhang, Yizhi

AU - Wang, Jiawei

AU - Chen, Lijiang

AU - Bi, Wenzi

AU - Lin, Jie

AU - Strugnell, Richard A.

AU - Zhang, Siqin

AU - Lithgow, Trevor

AU - Zhou, Tieli

AU - Cao, Jianming

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AB - Carbapenem-resistant, hypervirulent Klebsiella pneumoniae (CR-hvKP) has recently emerged as a significant threat to public health. In this study, 29 K. pneumoniae isolates were isolated from eight patients admitted to the intensive care unit (ICU) of a comprehensive teaching hospital located in China from March 2017 to January 2018. Clinical information of patients was the basis for the further analyses of the isolates including antimicrobial susceptibility tests, identification of antibiotic resistance and virulence gene determinants, multilocus sequence typing (MLST), XbaI-macrorestriction by pulsed-field gel electrophoresis (PFGE). Selected isolates representing distinct resistance profiles and virulence phenotypes were screened for hypervirulence in a Galleria mellonella larvae infection model. In the course of the outbreak, the overall mortality rate of patients was 100% (n = 8) attributed to complications arising from CR-hvKP infections. All isolates except one (28/29, 96.6%) were resistant to multiple antimicrobial agents, and harbored diverse resistance determinants that included the globally prevalent carbapenemase blaKPC−2. Most isolates had hypervirulent genotypes being positive for 19 virulence-associated genes, including iutA (25/29, 86.2%), rmpA (27/29, 93.1%), ybtA (27/29, 93.1%), entB (29/29, 100%), fimH (29/29, 100%), and mrkD (29/29, 100%). MLST revealed ST11 for the majority of isolates (26/29, 89,7%). Infection assays demonstrated high mortality in the Galleria mellonella model with the highest LD50 values for three isolates (<105 CFU/mL) demonstrating the degree of hypervirulence of these CR-hvKP isolates, and is discussed relative to previous outbreaks of CR-hvKP.

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