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在宿主间传播和演化期间，耐多药的 ST11 型肺炎克雷伯菌毒力异质性的表型和基因组表征
Authors Liu C, Du P, Zhao J, Li B, Wang C, Sun L, Lu B, Wang Y, Liu Y, Cao B
Received 26 December 2019
Accepted for publication 26 April 2020
Published 10 June 2020 Volume 2020:13 Pages 1713—1721
DOI https://doi.org/10.2147/IDR.S243836
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Dr Eric Nulens
Background: Multidrug-resistant (MDR) ST11 hypervirulent Klebsiella pneumoniae (hvKp) is emerging in China.
Purpose: The aim of this study was to track the transmission and evolution of hvKp.
Materials and Methods: A retrospective study focused on Kp infection was conducted. Clinical data were collected from electronic medical records. Whole-genome sequencing of Kp strains was performed. Single-nucleotide polymorphisms (SNPs) were analyzed and a transmission map was constructed. Sequence type, and antimicrobial and virulence-associated genes were characterized. Strains with some combination of the virulence genes, p rmpA, p rmpA2, iucA, iroB , and peg-344, were defined as hvKp. Kp virulence phenotypes were evaluated using the Galleria mellonella model.
Results: All 33 Kp strains were MDR-Kp and 13 (39.4%) were hvKp. Most hvKp strains (84.6%, 11/13) were hospital-acquired infections (HAIs). Two unique combinations of virulence-associated genes were detected among hvKp strains. Eleven cases were associated with p rmpA2 +iucA and two strains presented with peg-344 +p rmpA+p rmpA2 +iucA . Surprisingly, two community-acquired MDR-hvKp infection cases were identified. Eight hvKp strains (61.5%, 8/13) exhibited a hypervirulent phenotype in the G. mellonella model. Five MDR-hvKp strains with the hypervirulence phenotype originated from a single cluster. Additionally, nine clones were identified among the two clades, six of which were hvKp. Moreover, the hvKp in clade 1 carried the IncHI1B plasmid replicon, whereas none of the hvKp strains in clade 2 harbored IncHI1B. These data, showing that different hvKp clones distributed into separate clades, indicate that transmission and evolution occurred within the hospital.
Conclusion: During inter-host evolution and transmission, various virulence clusters of the epidemic clone, MDR-ST11, converged, conferring phenotypic virulence heterogeneity and spread within the hospital and possibly the community. Mobile/conjugative genetic elements associated with virulence-encoding gene clusters might emerge and have been transmitted within the hospital, suggesting that enhanced ongoing surveillance is essential.
Keywords: hypervirulent Klebsiella pneumoniae , multidrug resistance, whole-genome sequencing, hospital-acquired infection, community-acquired infection
