Identification of a Carbapenemase-Producing Hypervirulent Klebsiella pneumoniae Isolate in the United States

Abstract

We report on a carbapenemase-producing hypervirulent Klebsiella pneumoniae (CP-hvKP) isolate collected from a U.S. patient at an outpatient clinic. The isolate was identified as K. pneumoniae serotype K1 sequence type 23 and included both a hypervirulence (with rmpA, rmpA2 iroBCDN, peg-344, and iucABCD-iutA genes) and a carbapenemase-encoding (bla_KPC-2) plasmid. The emergence of CP-hvKP underscores the importance of clinical awareness of this pathotype and the need for continued monitoring of CP-hvKP in the United States.

Keywords: Klebsiella; hypervirulence; plasmid-mediated resistance.

FIG 1

Sequence alignment of the 227-kb pDHQP1701672_hv hypervirulence plasmid to the five most similar plasmids from an NCBI BLAST search. pVir-CR-HvKP267 was found in a K. pneumoniae ST11 isolate, and the other plasmids were from K. pneumoniae ST23. Similar plasmids were found in isolates from China (CN) and Australia (AU). Open reading frames (ORFs) of pDHQP1701672_hv are shown as the outermost ring, with plasmid replicons, virulence factors, and toxin-antitoxin systems highlighted.

FIG 2

Sequence alignment of the 121-kb pDHQP1701672_amr carbapenemase-encoding plasmid to the five most similar plasmids from an NCBI BLAST search. All of the plasmids were from CRE, four from K. pneumoniae and one (pBK33689) from E. coli isolates. Similar plasmids were found in isolates from Sweden (SE), the United States (US), and South Korea (KR). Open reading frames (ORFs) of pDHQP1701672_amr are shown as the outermost ring, with plasmid replicons, antimicrobial resistance (AMR) genes (*, including truncated bla_OXA-9), and toxin-antitoxin systems highlighted.