1. A Klebsiella pneumoniae ST307 outbreak clone from Germany demonstrates features of extensive drug resistance, hypermucoviscosity, and enhanced iron acquisition
- Author
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Jürgen A. Bohnert, Stephan Schaefer, Sören Gatermann, Wolfgang Gierer, Elias Eger, Veronika Balau, Sebastian Guenther, Nils-Olaf Hübner, Claus-Dieter Heidecke, Karsten Becker, Katharina Schaufler, Axel Kramer, Stefan E. Heiden, and Tim Eckmanns
- Subjects
0301 basic medicine ,Hypervirulence ,Klebsiella pneumoniae ,lcsh:Medicine ,Yersiniabactin ,Disease Outbreaks ,chemistry.chemical_compound ,Plasmid ,Germany ,Phylogeny ,Genetics (clinical) ,Virulence ,biology ,Anti-Bacterial Agents ,Molecular Medicine ,Aerobactin ,Plasmids ,lcsh:QH426-470 ,Virulence Factors ,Iron ,030106 microbiology ,Polymorphism, Single Nucleotide ,Microbiology ,03 medical and health sciences ,Antibiotic resistance ,Bacterial Proteins ,Drug Resistance, Bacterial ,Genetics ,Humans ,ddc:610 ,Molecular Biology ,Whole Genome Sequencing ,Research ,lcsh:R ,Outbreak ,Plasmid transmission ,biology.organism_classification ,Klebsiella Infections ,lcsh:Genetics ,030104 developmental biology ,chemistry ,Genes, Bacterial ,Biofilms ,610 Medizin und Gesundheit ,Enterobacter cloacae ,“Mosaic” plasmid ,XDR Klebsiella pneumoniae - Abstract
BackgroundAntibiotic-resistantKlebsiella pneumoniaeare a major cause of hospital- and community-acquired infections, including sepsis, liver abscess, and pneumonia, driven mainly by the emergence of successful high-risk clonal lineages. TheK. pneumoniaesequence type (ST) 307 lineage has appeared in several different parts of the world after first being described in Europe in 2008. From June to October 2019, we recorded an outbreak of an extensively drug-resistant ST307 lineage in four medical facilities in north-eastern Germany.MethodsHere, we investigated these isolates and those from subsequent cases in the same facilities. We performed whole-genome sequencing to study phylogenetics, microevolution, and plasmid transmission, as well as phenotypic experiments including growth curves, hypermucoviscosity, siderophore secretion, biofilm formation, desiccation resilience, serum survival, and heavy metal resistance for an in-depth characterization of this outbreak clone.ResultsPhylogenetics suggest a homogenous phylogram with several sub-clades containing either isolates from only one patient or isolates originating from different patients, suggesting inter-patient transmission. We identified three large resistance plasmids, carrying either NDM-1, CTX-M-15, or OXA-48, whichK. pneumoniaeST307 likely donated to otherK. pneumoniaeisolates of different STs and even other bacterial species (e.g.,Enterobacter cloacae) within the clinical settings. Several chromosomally and plasmid-encoded, hypervirulence-associated virulence factors (e.g., yersiniabactin, metabolite transporter, aerobactin, and heavy metal resistance genes) were identified in addition. While growth, biofilm formation, desiccation resilience, serum survival, and heavy metal resistance were comparable to several control strains, results from siderophore secretion and hypermucoviscosity experiments revealed superiority of the ST307 clone, similar to an archetypical, hypervirulentK. pneumoniaestrain (hvKP1).ConclusionsThe combination of extensive drug resistance and virulence, partly conferred through a “mosaic” plasmid carrying both antibiotic resistance and hypervirulence-associated features, demonstrates serious public health implications.
- Published
- 2020