ArticleScientific reports2024
A nosocomial outbreak of colistin and carbapenem-resistant hypervirulent Klebsiella pneumoniae in a large teaching hospital.
Article in Scientific reports, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Biofilm-Mediated Antimicrobial Resistance in PediatricAntibiotics (Basel, Switzerland) · 2026Review
- Molecular analysis of polymyxin B resistance in clinical carbapenem-resistant Klebsiella pneumoniae isolates from a large tertiary care teaching hospital in Southwest China.BMC microbiology · 2026Article
- Emergence and Genomic Characterization of a Hypervirulent Klebsiella pneumoniae Isolate From a New Clone in Brazil.Microbiology and immunology · 2026Article
- The dual threat of hypervirulent and multidrug-resistantFrontiers in microbiology · 2026Review
- Antimicrobial Resistance, Molecular Epidemiology, and Virulence Profiles of Hypervirulent Carbapenem-ResistantInfection and drug resistance · 2026Article
- Critical Care Management Considerations inCase reports in critical care · 2026Article
- NDM-1 plasmid clustering reflects clonal transmission of Klebsiella pneumoniae ST147 in four hospitals in Berlin, Germany.Antimicrobial resistance and infection control · 2025Article
- Polymyxin-resistant hypervirulentFrontiers in microbiology · 2025Article
- Unraveling the genome-wide repertoire of the novel chromosomally encodedFrontiers in microbiology · 2025Article
- Epidemiological and Antimicrobial Resistance Trends ofInfection and drug resistance · 2025Article
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6 authors.
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Abstract
Recently, colistin and carbapenem-resistant hypervirulent Klebsiella pneumoniae (CCR-hvKP) has been observed sporadically. The aim of this study was to report a nosocomial outbreak due to CCR-hvKP, so as to control the transmission of CCR-hvKP and prevent future outbreaks. The clinical characteristics of five involved cases were analyzed and infection prevention and control measures were documented. Five CCR-hvKP isolates were discovered from the five involved cases. Molecular features of the isolates including sequence type, capsule locus, antimicrobial resistance genes, virulence factors and phylogenetic relationship were analyzed by whole-genome sequencing. Validation of the role of the deleterious amino acid mutations to colistin resistance was examined by complementation assays. PCR was performed to identify insertion sequences within the mgrB gene. Mouse intraperitoneal infection models were used to assess virulence phenotype. Five cases infected with CCR-hvKP were identified with a high attributable mortality rate of 60% in the patients. The five outbreak isolates belonged to the high-risk ST11-KL64 clone and were closely clustered. They were highly resistant to commonly used antibiotics and showed hypervirulent in vivo. WGS revealed multiple antimicrobial resistance genes such as blaKPC-2 and blaCTX-M-65 and important virulence factors. Concerning colistin resistance, amino acid mutations G53S in pmrA gene, and T157P, T246A and R256G in pmrB gene were indentified. Among them, the deleterious mutation T157P in pmrB gene was validated to be responsible for the resistance phenotype of isolate KP01, KP03 and KP05. In addition, disruption of mgrB gene by insertion sequences of ISKpn26 and IS903B was indentified in isolate KP02 and KP04, respectively. This is the first report of an outbreak caused by CCR-hvKP. The study highlights infection prevention and control measures are key to successfully fight against CCR-hvKP dissemination and nosocomial infections. Continuous surveillance should be performed to limit the spread of these isolates.
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