Emergence of an XDR and carbapenemase-producing hypervirulent Klebsiella pneumoniae strain in Taiwan
Emergence of an XDR and carbapenemase-producing hypervirulent Klebsiella pneumoniae strain in Taiwan
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DOI：
10.1093/jac/dky164
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发表时间：
2018-08-01
影响因子：
5.2
通讯作者：
Yang, Tsuey-Ching
中科院分区：
文献类型：
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作者：
Huang, Yen-Hua;Chou, Sheng-Hua;Yang, Tsuey-Ching
背景：由于可用的治疗选择有限，产生碳青霉烯酶的肺炎克雷伯菌导致高死亡率。在这里，我们调查了台湾产 KPC-2 菌株中发现的一种新出现的碳青霉烯类抗药性高毒力肺炎克雷伯菌菌株。方法：2012 年 1 月至 2014 年 12 月期间从台北荣民总医院的临床标本中连续收集产 KPC 肺炎克雷伯菌菌株。荚膜类型和是否存在 分析了 rmpA/rmpA2，并使用这些菌株进行了 PFGE 和 MLST。 rmpA/rmpA2阳性菌株在小鼠体内致死研究中进行了测试，以验证其毒力，并进行全基因组测序以描绘其基因组特征。 结果：共鉴定出62株产KPC-2的肺炎克雷伯菌菌株；所有这些都属于ST11和荚膜基因型K47。从腹腔内脓肿死亡病例 (TVGHCRE225) 中分离出的一种菌株含有 rmpA 和 rmpA2 基因。该菌株除了对碳青霉烯类药物外，还对替加环素和粘菌素具有耐药性，并且不属于 PFGE 中的主要簇。 TVGHCRE225在小鼠致死实验中表现出高体内毒力。 WGS 显示，与经典的 ST11 KPC-2 生产菌株相比，TVGHCRE225 获得了一种新型杂合毒力质粒，该质粒包含一组毒力基因（iroBCDN、iucABCD、rmpA 和 rmpA2 以及 iutA）。结论：我们鉴定了一种携带杂合毒力的 XDR ST11 KPC-2 肺炎克雷伯菌菌株。 台湾的质粒。由于对人类健康的威胁迫在眉睫，因此有必要针对耐碳青霉烯类高毒力肺炎克雷伯菌菌株进行主动监测。
Background: Carbapenemase-producing Klebsiella pneumoniae causes high mortality owing to the limited therapeutic options available. Here, we investigated an emergent carbapenem-resistant K. pneumoniae strain with hypervirulence found among KPC-2-producing strains in Taiwan.Methods: KPC-producing K. pneumoniae strains were collected consecutively from clinical specimens at the Taipei Veterans General Hospital between January 2012 and December 2014. Capsular types and the presence of rmpA/rmpA2 were analysed, and PFGE and MLST performed using these strains. The strain positive for rmpA/rmpA2 was tested in an in vivo mouse lethality study to verify its virulence and subjected to WGS to delineate its genomic features.Results: A total of 62 KPC-2-producing K. pneumoniae strains were identified; all of these belonged to ST11 and capsular genotype K47. One strain isolated from a fatal case with intro-abdominal abscess (TVGHCRE225) harboured rmpA and rmpA2 genes. This strain was resistant to tigecycline and colistin, in addition to carbapenems, and did not belong to the major cluster in PFGE. TVGHCRE225 exhibited high in vivo virulence in the mouse lethality experiment. WGS showed that TVGHCRE225 acquired a novel hybrid virulence plasmid harbouring a set of virulence genes (iroBCDN, iucABCD, rmpA and rmpA2, and iutA) compared with the classic ST11 KPC-2-producing strain.Conclusions: We identified an XDR ST11 KPC-2-producing K. pneumoniae strain carrying a hybrid virulent plasmid in Taiwan. Active surveillance focusing on carbapenem-resistant hypervirulent K. pneumoniae strains is necessary, as the threat to human health is imminent.