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. 2025 Jun 4:15:1569004.
doi: 10.3389/fcimb.2025.1569004. eCollection 2025.

Molecular and epidemiological characterization of carbapenem-resistant hypervirulent Klebsiella pneumoniae in Huaian, China (2022-2024): a retrospective study

Jianchun Lian  1 , Qianhui Li  1 , Cheng Peng  1 , Tao Lin  1 , Hong Du  2 , Chaogui Tang  1 , Xiaoyun Zhang  1
Affiliations

Molecular and epidemiological characterization of carbapenem-resistant hypervirulent Klebsiella pneumoniae in Huaian, China (2022-2024): a retrospective study

Jianchun Lian et al. Front Cell Infect Microbiol. .

Abstract

Objectives: Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) poses a significant public health challenge. This study investigated the molecular epidemiology, antimicrobial resistance patterns, clinical characteristics, and risk factors of CR-hvKP infection in Huaian, China.

Methods: We retrospectively studied patients infected with carbapenem-resistant K. pneumoniae (CRKP) between November 2022 and September 2024. Whole-genome sequencing was used to detect carbapenemase, virulence, capsular serotype-related genes, and plasmid types in 374 CRKP isolates.

Results: Among them, 57.49% (215/374) strains met the criteria for CR-hvKP. The most common type was blaKPC-2-producing ST11(98.60%, 212/215), whereas K64 (56.74%, 122/215) and KL25 (39.53%, 85/215) were the main capsular serotypes. The CR-hvKP strains showed significantly higher resistance to the tested antibiotics, except for ceftazidime/avibactam and colistin. Resistance rates of CR-hvKP to the three tested antibiotics (minocycline, cotrimoxazole, and amikacin) were higher than those of CRnon-hvKP. Phylogenetic analysis based on whole-genome single-nucleotide polymorphisms divided the 251 isolates into four independent branches, with branch 2 being the most prevalent, indicating high clonality among the strains. Multivariate analysis showed diabetes [odds ratio (OR) = 3.771] and surgery (OR =2.042) to be independent variables associated with CR-hvKP infection.

Conclusions: Notably, the ST11 lineage carrying blaKPC-2 has emerged as a dominant high-risk clone in Huaian. Given the wide distribution of these novel CR-hvKP isolates, global monitoring and stricter control measures should be implemented to prevent their further spread in hospital settings.

Keywords: carbapenem-resistant hypervirulent Klebsiella pneumoniae; epidemiological characterization; molecular characterization; multidrug resistance; phylogenetic analysis; risk factors.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Distribution of plasmid types among 215 CR-hvKP strains. Data derived from whole-genome sequencing analysis of 215 CR-hvKP isolates. Plasmid types were identified using PlasmidFinder (threshold: >95% identity, >80% coverage). The six most prevalent plasmids (detection rate >60%) are highlighted in red, others in gray.
Figure 2
Figure 2
Phylogenetic analysis of 215 genomes of CR-hvKP. A maximum likelihood phylogenetic tree was constructed using the core genes of 215 K. pneumoniae isolates. The colors of the branches correspond to clades. Strips illustrate strain number, ST, KL types, number of resistance genes, year, and virulence score from inside to outside. The bar corresponds to the scale of sequence divergence.
Figure 3
Figure 3
Survival rates of larvae infected with eight distinct ST/KL-type CR-hvKP strains. There was no statistical difference in the survival rates between NTUH-K2044 and the eight CR-hvKP strains. A log-rank (Mantel-Cox) test was performed for the survival curves.
See this image and copyright information in PMC

References

    1. Carattoli A., Zankari E., García-Fernández A., Voldby Larsen M., Lund O., Villa L., et al. (2014). In silico detection and typing of plasmids using PlasmidFinder and plasmid multilocus sequence typing. Antimicrob. Agents Chemother. 58, 3895–3903. doi: 10.1128/aac.02412-14 - DOI - PMC - PubMed
    1. Cejas D., Fernández Canigia L., Rincón Cruz G., Elena A. X., Maldonado I., Gutkind G. O., et al. (2014). First isolate of KPC-2-producing Klebsiella pneumonaie sequence type 23 from the Americas. J. Clin. Microbiol. 52, 3483–3485. doi: 10.1128/jcm.00726-14 - DOI - PMC - PubMed
    1. CLSI (2021). Performance standards for antimicrobial susceptibility testing; 31th informational supplement (CLSI M100-S31) (Wayne: Clinical and Laboratory Standards Institute; ).
    1. Cui X., Shan B., Zhang X., Qu F., Jia W., Huang B., et al. (2020). Reduced ceftazidime-avibactam susceptibility in KPC-producing klebsiella pneumoniae from patients without ceftazidime-avibactam use history - A multicenter study in China. Front. Microbiol. 11. doi: 10.3389/fmicb.2020.01365 - DOI - PMC - PubMed
    1. Delcher A. L., Salzberg S. L., Phillippy A. M. (2003). Using MUMmer to identify similar regions in large sequence sets. Curr. Protoc. Bioinf. 10, 10.13.11-10.13.18. doi: 10.1002/0471250953.bi1003s00 - DOI - PubMed

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