Nosocomial transmission and rearrangement of large resistance-virulence hybrid plasmids between two bacteremic ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae strains with low fitness cost

Wenjian Liao; Qi-Sen Huang; DanDan Wei; Zhijuan Xiong; Fang-Ling Du; Tian-Xin Xiang; Shuihong Zhang; La-Gen Wan; Wei Zhang; Yang Liu

doi:10.1016/j.micpath.2022.105593

Nosocomial transmission and rearrangement of large resistance-virulence hybrid plasmids between two bacteremic ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae strains with low fitness cost

Microb Pathog. 2022 Jul:168:105593. doi: 10.1016/j.micpath.2022.105593. Epub 2022 May 17.

Authors

Wenjian Liao¹, Qi-Sen Huang², DanDan Wei², Zhijuan Xiong¹, Fang-Ling Du², Tian-Xin Xiang³, Shuihong Zhang⁴, La-Gen Wan², Wei Zhang⁵, Yang Liu⁶

Affiliations

¹ Department of Respiratory and Critical Care, First Affiliated Hospital of Nanchang University, Nanchang University, Yong wai zheng jie No. 17, Nanchang, 330006, PR China.
² Department of Clinical Microbiology, First Affiliated Hospital of Nanchang University, Nanchang University, Yong wai zheng jie No. 17, Nanchang, 330006, PR China.
³ Department of Infectious Disease, First Affiliated Hospital of Nanchang University, Nanchang University, Yong wai zheng jie No. 17, Nanchang, 330006, PR China.
⁴ Department of Geriatrics, Jiangxi kangning Hospital, Nanchang, 330006, PR China.
⁵ Department of Respiratory and Critical Care, First Affiliated Hospital of Nanchang University, Nanchang University, Yong wai zheng jie No. 17, Nanchang, 330006, PR China. Electronic address: zhangweiliuxin@163.com.
⁶ Department of Clinical Microbiology, First Affiliated Hospital of Nanchang University, Nanchang University, Yong wai zheng jie No. 17, Nanchang, 330006, PR China. Electronic address: ly13767160474@sina.com.

PMID: 35595177
DOI: 10.1016/j.micpath.2022.105593

Abstract

Objectives: To characterize nosocomial transmission and rearrangement of the resistance-virulence plasmid between two ST11-K64 carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) strains (JX-CR-hvKP-10 and JX-CR-hvKP-9) with low fitness.

Methods: Phenotypic tests were used to assess the virulence of JX-CR-hvKP-10 and JX-CR-hvKP-9. Whole-genome sequencing was used to analyze JX-CR-hvKP-10 and JX-CR-hvKP-9 chromosomes and plasmids. Fitness and conjugation experiments were also conducted using these two CR-hvKP isolates.

Results: Phenotypic tests indicated that both JX-CR-hvKP-10 and JX-CR-hvKP-9 were multidrug-resistant and hypervirulent K. pneumoniae. Whole-genome sequencing and clinical information demonstrated that the super large resistance-virulence fusion plasmid pJX10-1 formed precisely by the fusion of pJX9-1 and pJX9-2 via the nosocomial transmission. Interestingly pJX9-1 itself was also a classic resistance-virulence fusion plasmid by way of the bla_KPC-carrying resistance plasmid and pLVPK-like virulence plasmid. Compared with classic K. pneumoniae ATCC700603, fitness analysis revealed no significant difference in growth was observed between JX-CR-hvKP-10 and JX-CR-hvKP-9.

Conclusion: Nosocomial transmission and rearrangement of a bla_KPC-harboring plasmid and a pLVPK-like virulence plasmid with a low fitness cost in ST11 K. pneumoniae enhances drug resistance and virulence simultaneously. Thus, active surveillance of this hybrid plasmid is needed to prevent these efficient resistance-virulence plasmids from disseminating in hospital settings.

Keywords: Carbapenem resistance; Hypervirulent Klebsiella pneumoniae; KPC-2; Plasmid fusion; pLVPK-like virulence plasmid.

MeSH terms

Anti-Bacterial Agents / pharmacology
Bacteremia*
Carbapenem-Resistant Enterobacteriaceae* / genetics
Carbapenems / pharmacology
Cross Infection*
Humans
Klebsiella Infections* / epidemiology
Klebsiella pneumoniae
Plasmids / genetics
Virulence / genetics
beta-Lactamases / genetics

Substances

Anti-Bacterial Agents
Carbapenems
beta-Lactamases