Center for Genomics, Helmy Institute for Medical Sciences, Zewail City of Science and Technology, Giza, Egypt.
Biomedical Sciences Program, University of Science and Technology, Zewail City of Science and Technology, Giza, Egypt.
BMC Infect Dis. 2024 Oct 22;24(1):1193. doi: 10.1186/s12879-024-10056-1.
Ongoing studies have revealed the global prevalence of severe infections caused by the hypervirulent strains of Klebsiella pneumoniae (K. pneumoniae). Meanwhile, the World Health Organization and the Centers for Disease Control declared carbapenem-resistant K. pneumoniae as an urgent public health threat, requiring swift and effective action to mitigate its spread. Low- and middle-income countries are severely impacted by such devastating infectious diseases owing to the ill implementation of antimicrobial practices and infection control policies. Having both hypervirulence and carbapenemase gene determinants, the emergence of convergent hypervirulent carbapenem-resistant K. pneumoniae is now being reported worldwide.
In this study, we sequenced 19 carbapenemase-producing K. pneumoniae strains recovered from various clinical specimens. Additionally, we evaluated the phenotypic antimicrobial susceptibility to multiple antimicrobial classes using the VITEK2 automated system. Utilizing the sequencing data, we characterized the sequence types, serotypes, pangenome, resistance profiles, virulence profiles, and mobile genetic elements of the examined isolates. We highlighted the emergence of high-risk clones carrying hypervirulence genetic determinants among the screened isolates.
Our findings revealed that all carbapenem-resistant isolates exhibited either extensive- or pan-drug resistance and harbored multiple variants of resistance genes spanning nearly all the antimicrobial classes. The most prevalent carbapenemase genes detected within the isolates were bla and bla. We identified high-risk clones, such as ST383-K30, ST147-K64, ST11-K15, and ST14-K2, which may have evolved into putative convergent strains by acquiring the full set of hypervirulence-associated genetic determinants (iucABCD, rmpA and/ or rmpA2, putative transporter peg-344). Additionally, this study identified ST709-K9 as a high-risk clone for the first time and uncovered that capsule types K15 and K9 carried hypervirulence genetic determinants. The most frequent Inc types found in these isolates were Col440I, IncHI1B, and Inc FII(K).
This study highlights the emergence of high-risk, extensively carbapenem-resistant K. pneumoniae strains co-carrying hypervirulence determinants in Egyptian clinical settings. This poses an imminent threat not only to Egypt but also to the global community, underscoring the urgent need for enhanced surveillance and control strategies to combat this pathogen.
目前的研究已经揭示了由高毒力肺炎克雷伯菌（K. pneumoniae）引起的全球严重感染的流行情况。同时，世界卫生组织和疾病控制中心已将耐碳青霉烯类肺炎克雷伯菌宣布为紧急公共卫生威胁，需要迅速采取有效行动来遏制其传播。由于抗菌药物实践和感染控制政策执行不力，中低收入国家深受此类破坏性传染病的影响。具有高毒力和碳青霉烯酶基因决定簇的趋同高毒力耐碳青霉烯类肺炎克雷伯菌的出现现在正在全球范围内得到报道。
在本研究中，我们对从各种临床标本中分离出的 19 株产碳青霉烯酶肺炎克雷伯菌进行了测序。此外，我们还使用 VITEK2 自动化系统评估了多种抗菌药物类别的表型药敏性。利用测序数据，我们对检测到的分离株的序列类型、血清型、泛基因组、耐药谱、毒力谱和移动遗传元件进行了描述。我们强调了在筛选的分离株中出现携带高毒力遗传决定簇的高危克隆。
我们的研究结果表明，所有耐碳青霉烯类的分离株均表现出广泛或全耐药性，并携带几乎涵盖所有抗菌药物类别的多种耐药基因变体。在分离株中检测到的最常见的碳青霉烯酶基因是 bla 和 bla。我们发现了高危克隆，如 ST383-K30、ST147-K64、ST11-K15 和 ST14-K2，它们可能通过获得全套与高毒力相关的遗传决定簇（iucABCD、rmpA 和/或 rmpA2、假定转运蛋白 peg-344）而进化为假定的趋同株。此外，本研究首次发现 ST709-K9 为高危克隆，并发现荚膜型 K15 和 K9 携带高毒力遗传决定簇。在这些分离株中发现的最常见的 Inc 类型是 Col440I、IncHI1B 和 Inc FII(K)。
本研究强调了在埃及临床环境中出现的高风险、广泛耐碳青霉烯类肺炎克雷伯菌同时携带高毒力决定簇的情况。这不仅对埃及，而且对全球社会构成了迫在眉睫的威胁，突显了加强监测和控制策略以应对这种病原体的迫切需要。
