Abstract
Infection caused by carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) has become a tricky health care threat in China and KPC-2 enzyme is a main factor mediating resistance to carbapenems of K. pneumoniae. Here, we report the characterization of the genetic environment of the blaKPC-2 gene in CR-hvKP clinical isolates from South China. Forty-five non-duplicated CR-hvKP isolates collected in Jiangxi Province from 2018 to 2019 were analyzed. Each of them were multidrug-resistant due to the presence not only of blaKPC-2 gene but also of other resistance determinants, including Metallo-β-lactamases (NDM-1), extended-spectrum β-lactamases (TEM-1, CTX-M-14, SHV-1), and plasmid-mediated quinolone resistance determinants (qnrS, aac(6′)-Ib-cr). After plasmid analyses of PCR-based replicon typing (PBRT), mapping PCR, amplicon sequencing, and whole-genome sequencing (WGS) were used to analyze the genetic environment of the blaKPC-2 gene. PCR analysis of pLVPK-like plasmids, Southern Blot, and mouse lethality assay were used to characterize the virulence phenotype of K. pneumoniae. Multilocus sequence typing (MLST) analysis showed ST11 CR-hvKP was the predominant clone. In conclusion, this is the first analysis of diverse genetic structures blaKPC-2 gene in CR-hvKP isolates from south China. Both the NTEKPC-I on the IncF plasmids and pLVPK-like virulence plasmids make contributions to the formation of CR-hvKP especially ST11 which need more attention.
Highlights
Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hypervirulent K. pneumoniae (hvKP)) have become important pathogens of morbidity and mortality among hospital-acquired and long-term careassociated infections (Gu et al, 2018; Zhang et al, 2020)
This study aimed to present the genetic environment of blaKPC−2 in carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) isolates in Jiangxi Province using a series of PCR assays and whole-genome sequencing
PCR analysis of pLVPK-like plasmids revealed that all the CR-hvKP isolates were found to carry the pLVPKlike plasmid
Summary
Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) have become important pathogens of morbidity and mortality among hospital-acquired and long-term careassociated infections (Gu et al, 2018; Zhang et al, 2020). KPC-2, the most common variant of KPC carbapenemase enzymes, is a main factor mediating resistance to carbapenems of K. pneumoniae (Shen et al, 2016). Transmission of the KPC gene, blaKPC, can be mediated by different molecular mechanisms such as the mobility of small genetic elements, horizontal transfer of plasmids, and the clonal spread (Munoz-Price and Quinn, 2009). BlaKPC-bearing nonTn4401 elements (NTEKPC) were first reported on the plasmid pKP048 from a Chinese clinical K. pneumoniae isolate in 2009 (Shen et al, 2009). In a review about molecular and genetic decoding in carbapenemaseproducing Klebsiella pneumoniae, NTEKPC has been divided into three groups (NTEKPC I, NTEKPC II, and NTEKPC III) on the basis of the genes adjacent to blaKPC (Chen et al, 2014)
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