#Evolution of #hypervirulence in #carbapenem-resistant #Klebsiella pneumoniae in #China: a multicentre, molecular epidemiological analysis (J Antimicrob Chemother., abstract)

[Source: Journal of Antimicrobial Chemotherapy, full page: (LINK). Abstract, edited.]

Evolution of hypervirulence in carbapenem-resistant Klebsiella pneumoniae in China: a multicentre, molecular epidemiological analysis

Yawei Zhang, Longyang Jin, Pengwen Ouyang, Qi Wang, Ruobing Wang, Juan Wang, Hua Gao, Xiaojuan Wang, Hui Wang on behalf of the China Carbapenem-Resistant Enterobacteriaceae (CRE) Network

Journal of Antimicrobial Chemotherapy, dkz446, https://doi.org/10.1093/jac/dkz446

Published: 12 November 2019




Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) have been increasingly reported in China. Here, a multicentre, longitudinal surveillance study on CR-hvKP is described.


We retrospectively investigated carbapenem-resistant K. pneumoniae (CRKP) in 56 centres across China during 2015–17 and screened the virulence genes (iucA, iroN, rmpA and rmpA2) for the presence of virulence plasmids. Hypermucoviscosity, serum killing and Galleria mellonella lethality experiments were conducted to identify CR-hvKP among strains with all four virulence genes. Capsule typing, fitness and plasmid features of CR-hvKP were also investigated.


A total of 1052 CRKP were collected. Among these, 34.2% (360/1052) carried virulence genes and 72 of them had all four of the virulence genes tested. Fifty-five (76.4%) were considered to be CR-hvKP using the G. mellonella infection model, with KPC-2-producing K64-ST11 being the most common type (80%, 44/55). Prevalence of CR-hvKP differed greatly between regions, with the highest in Henan (25.4%, 17/67) and Shandong (25.8%, 25/97). A significant increase in CR-hvKP among KPC-2-producing ST11 strains was observed, from 2.1% (3/141) in 2015 to 7.0% (23/329) in 2017 (P = 0.045). Alarmingly, compared with classic CRKP, no difference in growth was found among CR-hvKP (P = 0.7028), suggesting a potential risk for dissemination. The hybrid virulence and resistance-encoding plasmid evolved from pLVPK and the resistance plasmid harbouring blaKPC-2, indicating evolution existed between the hypervirulence and hyper-resistance plasmid.


CR-hvKP were more frequently detected than previously assumed, especially among KPC-2-producing ST11. Dissemination of hypervirulence could be extremely rapid due to limited fitness cost. Also, the evolution of resistance genes into hypervirulence plasmids was identified, presenting significant challenges for public health and infection control.


© The Author(s) 2019. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please email: journals.permissions@oup.com.

This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model)

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Klebsiella pneumoniae; Plasmids; China.


Analysis of #drug #resistance of #ESBL-producing #Escherichia coli and #Klebsiella pneumoniae in #children with #UTI (Saudi Med J., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Saudi Med J. 2019 Nov;40(11):1111-1115. doi: 10.15537/smj.2019.11.24547.

Analysis of drug resistance of extended-spectrum beta-lactamases-producing Escherichia coli and Klebsiella pneumoniae in children with urinary tract infection.

Keshi L1, Weiwei X, Shoulin L, Xiadong L, Hao W, Junhai J, Xiangwei W, Rui W, Pei Z.

Author information: 1 Department of Urology, Shenzhen Children’s Hospital,Shenzhen,Guangdong Province, China. E-mail. keshilu@szu.edu.cn.




To investigate the drug resistance of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (E. coli ) and Klebsiella pneumoniae (K. pneumoniae) in children with urinary tract infection  (UTI) and to provide the rationale for clinical use of antibiotics.


This is a retrospective analysis of drug susceptibility in children with E. coli or K. pneumoniae-positive urine culture between August 2013 and August 2017,  Shenzhen Children’s Hospital, Shenzhen, China. Drug resistance was statistically assessed using Fisher exact test and χ2 test.


A total of 698 cases of E. coli, 426 of which were confirmed ESBL-producing strains, and 217 cases of K. pneumoniae, including 111 ESBL-producing strains, were detected, and the difference in proportion of positive ESBL-producing strains (61.03% versus 51.15%) was statistically significant (p=0.010). The average drug resistance rates of E. coli and K. pneumoniae to piperacillin/tazobactam, meropenem, ertapenem, imipenem, and amikacin were less than 15%. The average resistance rates of ESBL-producing E. coli and K. pneumoniae to cefpodoxime, cefixime, cefazolin, and ceftriaxone was less than 98%, while average resistance rates for non-ESBL-producing bacteria to the above 4 drugs was less than 20%.


In southern China, the proportion of ESBL-producing strains and the drug resistance rates of E. coli and K. pneumoniae in UTI in children was high, but their resistance rates to carbapenems and β-lactamase inhibitor complexes containing tazobactam were low. Carbapenems are the most effective antibacterial drugs for the treatment of ESBL-producing bacteria.

PMID: 31707407 DOI: 10.15537/smj.2019.11.24547

Keywords: Antibiotics; Drugs Resistance; Beta-lactams; Carbapenem; E. Coli; Klebsiella pneumoniae; UTI; China; Pediatrics.


A 7-year #surveillance of the #drug #resistance in #Klebsiella pneumoniae from a primary #healthcare center (Ann Clin Microbiol Antimicrob., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Ann Clin Microbiol Antimicrob. 2019 Nov 9;18(1):34. doi: 10.1186/s12941-019-0335-8.

A 7-year surveillance of the drug resistance in Klebsiella pneumoniae from a primary health care center.

Li G1, Zhao S1, Wang S1, Sun Y1, Zhou Y1, Pan X2.

Author information: 1 Department of Clinical Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, Dongyang, Zhejiang, China. 2 Department of Biomedical Sciences Laboratory, Affiliated Dongyang Hospital of Wenzhou Medical University, No. 60 Wuningxi Road, Dongyang, Zhejiang, China. panfengyuwuzu@163.com.




The increased prevalence of Klebsiella pneumoniae infections and resistance rates are a current cause for concern. However, data for resistance rates in K. pneumoniae strains from primary hospitals and the resistance distribution among the different isolate sample sources are scarce.


All the K. pneumoniae strains were isolated from patients who visited a primary health care center located in Central Zhejiang Province from January 2011 to December 2017. The specimens included blood, sputum, cervical secretions and urine. The species were identified by the Vitek 2 Compact Bacterial Identification and Monitoring System or VITEK-MS and the extended spectrum β-lactamase (ESBL) and drug resistance profiles were identified using the AST-GN13 Gram negative susceptibility card (VITEK-2). The genotype of strains from urine sources was analyzed by detecting TEM and SHV genes. Finally, the drug resistance rates among the isolates from different sample sources were analyzed using the Chi square test with SPSS software.


A total of 5319 K. pneumoniae strains were isolated in this study. Among the 20 antimicrobial drugs studied, the resistance rates of K. pneumoniae strains varied from 1.4% (ertapenem) to 23.1% (nitrofurantoin). The antibiotic resistance rates varied significantly among the isolate samples sources for all, with the highest rates for all antibiotics except for nitrofurantoin found in urine samples. In addition, the ESBL-positive rate in urine samples was 27.1%, significantly higher than that of cervical secretions (20.2%), blood (16.5%) and sputum (15.2%). Compared to the ESBL-negative strains, higher resistance rates were detected in the ESBL-positive strains. The most common genotype of isolates from urine was SHV (28%, 23/82), following by TEM (14.6%, 12/82).


The highest resistance rates of K. pneumoniae strains to most antibiotics found in urine samples are partly due to the ESBLs, indicating that a special attention should be paid in the treatment of urinary tract infection.

KEYWORDS: Drug resistance; ESBL; Klebsiella pneumoniae; Urine

PMID: 31706307 DOI: 10.1186/s12941-019-0335-8

Keywords: Antibiotics; Drugs Resistance; UTI; China; Nosocomial outbreaks.


Simultaneous #Infection with #Enterobacteriaceae and #Pseudomonas aeruginosa harboring Multiple #Carbapenemases in a Returning #Traveler colonized with #Candida auris (AAC, abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Simultaneous Infection with Enterobacteriaceae and Pseudomonas aeruginosa harboring Multiple Carbapenemases in a Returning Traveler colonized with Candida auris

Ayesha Khan, William C. Shropshire, Blake Hanson, An Q. Dinh, Audrey Wanger, Luis Ostrosky-Zeichner, Cesar A. Arias, William R. Miller

DOI: 10.1128/AAC.01466-19



We report our clinical experience treating a critically ill patient with polymicrobial infections due to multi-drug resistant Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa in a 56 year-old woman who received healthcare in India and was also colonized by Candida auris. A precision medicine approach using whole genome sequencing revealed a multiplicity of mobile elements associated with NDM-1, NDM-5, and OXA-181 and, supplemented by susceptibility testing, guided the selection of rational antimicrobial therapy.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; NDM1; E. Coli; Klebsiella pneumoniae; Pseudomonas aeruginosa; Candida auris.


#Contamination of #hospital #surfaces with #respiratory #pathogens in #Bangladesh (PLOS One, abstract)

[Source: PLoS One, full page: (LINK). Abstract, edited.]


Contamination of hospital surfaces with respiratory pathogens in Bangladesh

Md. Zakiul Hassan , Katharine Sturm-Ramirez, Mohammad Ziaur Rahman, Kamal Hossain, Mohammad Abdul Aleem, Mejbah Uddin Bhuiyan, Md. Muzahidul Islam, Mahmudur Rahman, Emily S. Gurley


Published: October 28, 2019 / DOI: https://doi.org/10.1371/journal.pone.0224065



With limited infection control practices in overcrowded Bangladeshi hospitals, surfaces may play an important role in the transmission of respiratory pathogens in hospital wards and pose a serious risk of infection for patients, health care workers, caregivers and visitors. In this study, we aimed to identify if surfaces near hospitalized patients with respiratory infections were contaminated with respiratory pathogens and to identify which surfaces were most commonly contaminated. Between September-November 2013, we collected respiratory (nasopharyngeal and oropharyngeal) swabs from patients hospitalized with respiratory illness in adult medicine and paediatric medicine wards at two public tertiary care hospitals in Bangladesh. We collected surface swabs from up to five surfaces near each case-patient including: the wall, bed rail, bed sheet, clinical file, and multipurpose towel used for care giving purposes. We tested swabs using real-time multiplex PCR for 19 viral and 12 bacterial pathogens. Case-patients with at least one pathogen detected had corresponding surface swabs tested for those same pathogens. Of 104 patients tested, 79 had a laboratory-confirmed respiratory pathogen. Of the 287 swabs collected from surfaces near these patients, 133 (46%) had evidence of contamination with at least one pathogen. The most commonly contaminated surfaces were the bed sheet and the towel. Sixty-two percent of patients with a laboratory-confirmed respiratory pathgen (49/79) had detectable viral or bacterial nucleic acid on at least one surface. Klebsiella pneumoniae was the most frequently detected pathogen on both respiratory swabs (32%, 33/104) and on surfaces near patients positive for this organism (97%, 32/33). Surfaces near patients hospitalized with respiratory infections were frequently contaminated by pathogens, with Klebsiella pneumoniae being most common, highlighting the potential for transmission of respiratory pathogens via surfaces. Efforts to introduce routine cleaning in wards may be a feasible strategy to improve infection control, given that severe space constraints prohibit cohorting patients with respiratory illness.


Citation: Hassan MZ, Sturm-Ramirez K, Rahman MZ, Hossain K, Aleem MA, Bhuiyan MU, et al. (2019) Contamination of hospital surfaces with respiratory pathogens in Bangladesh. PLoS ONE 14(10): e0224065. https://doi.org/10.1371/journal.pone.0224065

Editor: Sarah Tschudin-Sutter, University Hospital Basel, SWITZERLAND

Received: February 11, 2019; Accepted: October 4, 2019; Published: October 28, 2019

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: All relevant data are within the paper and its Supporting Information files.

Funding: Emily S Gurley received the funding award. The Grant No. is GR-00720 (cooperative agreement number 5U01CI000628). The study was funded by the Centers for Disease Control and Prevention (CDC), Atlanta (https://www.cdc.gov/). US CDC provided technical support in the study design, data collection and analysis and preparation of the manuscript

Competing interests: The authors have declared that no competing interests exist

Keywords: Infectious diseases; Nosocomial outbreaks; Klebsiella pneumoniae; Bangladesh.


Broad and Efficient Control of #Klebsiella #Pathogens by #Peptidoglycan-Degrading and Pore-Forming #Bacteriocins #Klebicins (Sci Rep., abstract)

[Source: Scientific Reports, full page: (LINK). Abstract, edited.]

Broad and Efficient Control of Klebsiella Pathogens by Peptidoglycan-Degrading and Pore-Forming Bacteriocins Klebicins

Erna Denkovskienė, Šarūnas Paškevičius, Audrius Misiūnas, Benita Stočkūnaitė, Urtė Starkevič, Astra Vitkauskienė, Simone Hahn-Löbmann, Steve Schulz, Anatoli Giritch, Yuri Gleba & Aušra Ražanskienė

Scientific Reports, volume 9, Article number: 15422 (2019)



Gram-negative bacteria belonging to the genus Klebsiella are important nosocomial pathogens, readily acquiring resistance to all known antibiotics. Bacteriocins, non-antibiotic antibacterial proteins, have been earlier proposed as potential therapeutic agents for control of other Gram-negative species such as Escherichia, Pseudomonas and Salmonella. This study is the first report describing pore-forming and peptidoglycan-degrading bacteriocins klebicins from Klebsiella. We have identified, cloned, expressed in plants and characterized nine pore-forming and peptidoglycan-degrading bacteriocins from different Klebsiella species. We demonstrate that klebicins can be used for broad and efficient control of 101 of the 107 clinical isolates representing five Klebsiella species, including multi-drug resistant pathovars and pathovars resistant to carbapenem antibiotics.

Keywords: Antibiotics; Drugs Resistance; Klebsiella pneumoniae; Carbapenem; Bacteriocins.


Successful #treatment of chronic relapsing #UTI with #bacteriophages in a renal transplant recipient – a Dutch case report (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Successful treatment of chronic relapsing urinary tract infection with bacteriophages in a renal transplant recipient – a Dutch case report

Saskia Kuipers, Mike M Ruth, Mike Mientjes, Ruud G. L. de Sévaux, Jakko van Ingen

DOI: 10.1128/AAC.01281-19



We report a case of a 58-year old renal transplant patient who developed recurrent urinary tract infection with an ESBL-positive Klebsiella pneumoniae strain in the first month post-transplant. Even though carbapenems tested susceptible and despite repeated meropenem treatment, his infection recurred. The infection eventually evolved into epididymitis that was successfully treated with meropenem and bacteriophages. This case demonstrates the difficulty of treating relapsing ESBL-positive Gram-negative infections in renal transplant patients.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Klebsiella pneumoniae; Bacteriophages.