School of Industrial Fisheries, Cochin University of Science and Technology (CUSAT), 682016, India.
Department of Marine Biology, Microbiology and Biochemistry, Cochin University of Science and Technology (CUSAT), 682016, India.
Sci Total Environ. 2022 Jan 1;802:149859. doi: 10.1016/j.scitotenv.2021.149859. Epub 2021 Aug 25.
The global emergence of antimicrobial resistance (AMR) among pathogens is a major public health crisis that might soon lead to a post-antibiotic era. Klebsiella pneumoniae, included in the World Health Organization list of critical priority pathogens, is an emerging threat to global health owing to the rapid rise of convergent AMR and hypervirulent strains. Comprehensive epidemiology of AMR-hypervirulent determinants in K. pneumoniae from Low-and Middle-Income Countries (LMICs) is still lacking. As part of rapid risk assessment, an in-silico approach was employed to characterize the AMR and hypervirulence determinants in K. pneumoniae from LMICs. Genomic data of 2432 K. pneumoniae strains were obtained from 33 LMICs representing 4 continents; Asia (n = 12), Africa (n = 18), N. America (n = 2) and Europe (n = 1). All the analysed strains were multiple-drug resistant and 13.6% of them were hypervirulent as well. The co-existence of antibiotic resistant genes conferring concomitant resistance towards life-saving drugs (carbapenems, colistin, fluoroquinolones and fosfomycin) were also observed among the strains, thereby challenging the efficacy of current treatment strategies. The emergence of convergent strains of K. pneumoniae carrying both multi-drug resistance and hypervirulence-associated genes in 12 LMICs is highlighted in this study. Asian region was identified as the major hotspot for convergent strains, especially being confined to 3 countries (India, Pakistan and Vietnam), further exacerbating the situation. This represents a major challenge to disease treatment and public health management in the LMICs. Regular surveillance for emergence of convergence and necessary interventions in the high-risk regions are strongly recommended.
全球病原体对抗微生物药物耐药性（AMR）的出现是一个主要的公共卫生危机，这可能很快会导致后抗生素时代的到来。肺炎克雷伯菌被世界卫生组织列入关键优先病原体名单，由于快速出现的抗微生物药物耐药性和高毒力菌株，它对全球健康构成了新的威胁。在低收入和中等收入国家（LMICs）中，肺炎克雷伯菌的 AMR-高毒力决定因素的综合流行病学仍然缺乏。作为快速风险评估的一部分，采用了一种计算机模拟方法来描述来自 LMICs 的肺炎克雷伯菌的 AMR 和高毒力决定因素。从代表四大洲的 33 个 LMICs 中获得了 2432 株肺炎克雷伯菌的基因组数据；亚洲（n=12）、非洲（n=18）、北美（n=2）和欧洲（n=1）。所有分析的菌株均为多药耐药性，其中 13.6%也是高毒力的。同时还观察到了同时对挽救生命的药物（碳青霉烯类、粘菌素、氟喹诺酮类和磷霉素）具有抗药性的抗生素耐药基因的共存，从而对当前的治疗策略的疗效构成了挑战。本研究强调了在 12 个 LMICs 中同时出现携带多药耐药性和高毒力相关基因的肺炎克雷伯菌的趋同菌株。亚洲地区被确定为趋同菌株的主要热点地区，特别是仅限于 3 个国家（印度、巴基斯坦和越南），进一步加剧了这种情况。这对 LMICs 的疾病治疗和公共卫生管理构成了重大挑战。强烈建议对趋同的出现进行定期监测，并在高风险地区进行必要的干预。
