Stool Samples of Acute Diarrhea Inpatients as a Reservoir of ST11 Hypervirulent KPC-2-Producing <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>

ABSTRACT The emergence and spread of carbapenem-resistant hypervirulent Klebsiella pneumoniae sequence type 11 (ST11-CR-HvKP) in China are a great concern in the public health community. However, the underlying mechanism that enables its wide dissemination in China remains unclear. Here, we investig...

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Autores principales:	Beiwen Zheng, Hao Xu, Tao Lv, Lihua Guo, Yu Xiao, Chen Huang, Shuntian Zhang, Yunbo Chen, Huiming Han, Ping Shen, Yonghong Xiao, Lanjuan Li
Formato:	article
Lenguaje:	EN
Publicado:	American Society for Microbiology 2020
Materias:	gut hypervirulent KPC-2 reservoir genomic characterization Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/1411a36b0e404c2e86d4eb2f153492af
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spelling	oai:doaj.org-article:1411a36b0e404c2e86d4eb2f153492af2021-12-02T18:44:35ZStool Samples of Acute Diarrhea Inpatients as a Reservoir of ST11 Hypervirulent KPC-2-Producing <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>10.1128/mSystems.00498-202379-5077https://doaj.org/article/1411a36b0e404c2e86d4eb2f153492af2020-06-01T00:00:00Zhttps://journals.asm.org/doi/10.1128/mSystems.00498-20https://doaj.org/toc/2379-5077ABSTRACT The emergence and spread of carbapenem-resistant hypervirulent Klebsiella pneumoniae sequence type 11 (ST11-CR-HvKP) in China are a great concern in the public health community. However, the underlying mechanism that enables its wide dissemination in China remains unclear. Here, we investigated the prevalence of carriage of carbapenemase-producing Enterobacteriaceae (CPE) among inpatients with diarrhea in a teaching hospital over 1 year to identify ST11-CR-HvKP reservoirs and to understand the genetic background and plasmid profiles of these pathogens. As assessed by stool analysis, the CPE colonization rate (12.4%) among the inpatients with diarrhea was high (12.4%). Antibiotic exposure, surgical history, and CPE positivity were correlated. Genomic investigation of 65 carbapenem-resistant K. pneumoniae isolates indicated a shared bacterial population in various wards. According to maximum likelihood phylogenetic tree analysis, these isolates were partitioned into three major clades. Analysis of the wzi locus revealed three different K types (KL105, KL47, and K64) among the ST11 isolates, indicating the genetic diversity of these isolates. Genetic and sequence mapping revealed the complexity of virulence and resistance plasmid sets harbored by the isolates. These observations indicate that the dissemination of resistant bacteria is more complex than initially anticipated and possibly involves multiple K. pneumoniae ST11 lineages and a variety of virulence plasmids. Collectively, we show for the first time that stool may be a source of ST11-CR-HvKP isolates. Furthermore, the findings reveal the silent dissemination of ST11-CR-HvKP bacteria in Zhejiang Province, China. Future investigations are warranted to determine the association between rectal colonization by ST11-CR-HvKP and clinical infections. IMPORTANCE China has been experiencing a rapid increase in the number of nosocomial infections caused by carbapenem-resistant Klebsiella pneumoniae ST11 (ST11-CRKP) for decades. The emergence of hypervirulent ST11-CRKP (ST11-CR-HvKP) strains is expected to become a serious public health issue in China, considering that carbapenem resistance and virulence have converged in an epidemic clone. K. pneumoniae strains that colonize the human intestinal tract may become a reservoir of virulence and carbapenemase-encoding genes. Here, we first characterized the genotypes and antimicrobial phenotypes of ST11-CR-HvKP strains isolated from diarrheal stool samples of inpatients in Zhejiang Province, China. Active surveillance approaches based on the findings of the present study should be implemented, particularly in intensive care units, to combat the spread of ST11-CR-HvKP and to improve treatment.Beiwen ZhengHao XuTao LvLihua GuoYu XiaoChen HuangShuntian ZhangYunbo ChenHuiming HanPing ShenYonghong XiaoLanjuan LiAmerican Society for MicrobiologyarticleguthypervirulentKPC-2reservoirgenomic characterizationMicrobiologyQR1-502ENmSystems, Vol 5, Iss 3 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	gut hypervirulent KPC-2 reservoir genomic characterization Microbiology QR1-502
spellingShingle	gut hypervirulent KPC-2 reservoir genomic characterization Microbiology QR1-502 Beiwen Zheng Hao Xu Tao Lv Lihua Guo Yu Xiao Chen Huang Shuntian Zhang Yunbo Chen Huiming Han Ping Shen Yonghong Xiao Lanjuan Li Stool Samples of Acute Diarrhea Inpatients as a Reservoir of ST11 Hypervirulent KPC-2-Producing <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
description	ABSTRACT The emergence and spread of carbapenem-resistant hypervirulent Klebsiella pneumoniae sequence type 11 (ST11-CR-HvKP) in China are a great concern in the public health community. However, the underlying mechanism that enables its wide dissemination in China remains unclear. Here, we investigated the prevalence of carriage of carbapenemase-producing Enterobacteriaceae (CPE) among inpatients with diarrhea in a teaching hospital over 1 year to identify ST11-CR-HvKP reservoirs and to understand the genetic background and plasmid profiles of these pathogens. As assessed by stool analysis, the CPE colonization rate (12.4%) among the inpatients with diarrhea was high (12.4%). Antibiotic exposure, surgical history, and CPE positivity were correlated. Genomic investigation of 65 carbapenem-resistant K. pneumoniae isolates indicated a shared bacterial population in various wards. According to maximum likelihood phylogenetic tree analysis, these isolates were partitioned into three major clades. Analysis of the wzi locus revealed three different K types (KL105, KL47, and K64) among the ST11 isolates, indicating the genetic diversity of these isolates. Genetic and sequence mapping revealed the complexity of virulence and resistance plasmid sets harbored by the isolates. These observations indicate that the dissemination of resistant bacteria is more complex than initially anticipated and possibly involves multiple K. pneumoniae ST11 lineages and a variety of virulence plasmids. Collectively, we show for the first time that stool may be a source of ST11-CR-HvKP isolates. Furthermore, the findings reveal the silent dissemination of ST11-CR-HvKP bacteria in Zhejiang Province, China. Future investigations are warranted to determine the association between rectal colonization by ST11-CR-HvKP and clinical infections. IMPORTANCE China has been experiencing a rapid increase in the number of nosocomial infections caused by carbapenem-resistant Klebsiella pneumoniae ST11 (ST11-CRKP) for decades. The emergence of hypervirulent ST11-CRKP (ST11-CR-HvKP) strains is expected to become a serious public health issue in China, considering that carbapenem resistance and virulence have converged in an epidemic clone. K. pneumoniae strains that colonize the human intestinal tract may become a reservoir of virulence and carbapenemase-encoding genes. Here, we first characterized the genotypes and antimicrobial phenotypes of ST11-CR-HvKP strains isolated from diarrheal stool samples of inpatients in Zhejiang Province, China. Active surveillance approaches based on the findings of the present study should be implemented, particularly in intensive care units, to combat the spread of ST11-CR-HvKP and to improve treatment.
format	article
author	Beiwen Zheng Hao Xu Tao Lv Lihua Guo Yu Xiao Chen Huang Shuntian Zhang Yunbo Chen Huiming Han Ping Shen Yonghong Xiao Lanjuan Li
author_facet	Beiwen Zheng Hao Xu Tao Lv Lihua Guo Yu Xiao Chen Huang Shuntian Zhang Yunbo Chen Huiming Han Ping Shen Yonghong Xiao Lanjuan Li
author_sort	Beiwen Zheng
title	Stool Samples of Acute Diarrhea Inpatients as a Reservoir of ST11 Hypervirulent KPC-2-Producing <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
title_short	Stool Samples of Acute Diarrhea Inpatients as a Reservoir of ST11 Hypervirulent KPC-2-Producing <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
title_full	Stool Samples of Acute Diarrhea Inpatients as a Reservoir of ST11 Hypervirulent KPC-2-Producing <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
title_fullStr	Stool Samples of Acute Diarrhea Inpatients as a Reservoir of ST11 Hypervirulent KPC-2-Producing <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
title_full_unstemmed	Stool Samples of Acute Diarrhea Inpatients as a Reservoir of ST11 Hypervirulent KPC-2-Producing <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>
title_sort	stool samples of acute diarrhea inpatients as a reservoir of st11 hypervirulent kpc-2-producing <named-content content-type="genus-species">klebsiella pneumoniae</named-content>
publisher	American Society for Microbiology
publishDate	2020
url	https://doaj.org/article/1411a36b0e404c2e86d4eb2f153492af
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Stool Samples of Acute Diarrhea Inpatients as a Reservoir of ST11 Hypervirulent KPC-2-Producing <named-content content-type="genus-species">Klebsiella pneumoniae</named-content>

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