ArticleEBioMedicine2026
Clinical characteristics and molecular epidemiology of KPC-NDM co-producing carbapenem-resistant Klebsiella pneumoniae in China: a multicentre retrospective case-control study.
Article in EBioMedicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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4 citing papers in PubMed.
- Article
- Molecular characterization of carbapenem resistance and hypervirulence determinants of Klebsiella pneumoniae circulating in a tertiary hospital in Cyprus.Molecular biology reports · 2026Article
- KPC-2 Orchestrates Systemic Metabolic Rewiring to Facilitate Antibiotic Adaptation inMicroorganisms · 2026Article
- Characterization of a conjugative IncA plasmid co-harbouringFrontiers in microbiology · 2026Article
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Abstract
backgroundKPC and NDM co-producing carbapenem-resistant Klebsiella pneumoniae (KN-CRKP) is an escalating global health threat with limited treatment options.
methodsHere, we conducted a multicentre retrospective case-control study on KN-CRKP in China (2020-2025), collecting 3012 non-duplicated CRKP isolates, of which 71 (2.4%) were KN-CRKP. For clinical analysis, 39 patients with KN-CRKP infections were identified from 71 isolates and matched in a 1:2 ratio with 78 patients infected by KPC-2-producing CRKP. For global analysis, we retrieved 100,141 genomes from GenBank, of which 662 non-redundant KN-CRKP sequences were combined with our 71 KN-CRKP isolates. Antimicrobial susceptibility testing, whole-genome sequencing (WGS), plasmid transfer and stability, fitness cost, transcriptomics and Bayesian phylogeography were used to investigate evolution mechanisms and molecular epidemiology of KN-CRKP strains.
findingsAmong the infected patients, hospital-acquired or ventilator-associated pneumonia was the most common (41.0%, 16/39). Patients with KN-CRKP infections had a non-significantly higher 28-day mortality (38.5%, 15/39) than the KPC-CRKP control group (24.4%, 19/78; p = 0.133), but a significantly higher in-hospital mortality (46.2%, 18/39 vs. 25.6%, 20/78; p = 0.036). Independent risk factors included diabetes, a history of CRO (carbapenem-resistant gram-negative organism) infection treated with ceftazidime-avibactam (CZA) treatment, and recent use of β-lactam/β-lactamase inhibitor combinations. All KN-CRKP isolates were resistant to carbapenems and CZA, but exhibited highly susceptible to colistin (98.6%), cefiderocol (94.4%), and aztreonam-avibactam (100%). The predominant KN-CRKP clones were ST11 (73.2%) and ST307 (15.5%). Global surveillance of 733 global KN-CRKP identified ST11 as a pandemic lineage diverging into China/Brazil subclusters, with emerging clones ST147/ST307 showing post-pandemic increases. Plasmid profiling revealed bla
interpretationThe high mortality and global prevalence of KN-CRKP emphasise the need for enhanced surveillance and infection control globally.
fundingNational Natural Science Foundation of China (82472323 and 82172306), Zhejiang Province Natural Science Foundation of China (LQN26H200003, LR25H200001, LQN25H200002, MS25H190009), the "Pioneer" and "Leading Goose" R&D Program of Zhejiang Province (2025C02187), the Zhejiang Provincial Medical and Health Technology Project (2025HY0224) and Zhejiang Provincial Disease Prevention and Control Science and Technology Program (2025JK063). We appreciate the statistical support provided by Hui Liu (Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China).
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