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High prevalence of KPC-2-producing hypervirulent Klebsiella pneumoniae causing meningitis in Eastern China
Min Xu1, Yiqi Fu2, Yunhui Fang3
1Key Laboratory of Clinical In Vitro Diagnostic Techniques of Zhejiang Province, Center of Clinical Laboratory, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Background:
Klebsiella pneumoniae has been the leading causative pathogen for adult bacterial meningitis in several Asian countries. The clinical and microbiological characteristics of K. pneumoniae meningitis in mainland China are still unknown.
Materials And Methods:
The clinical data of patients with K. pneumoniae meningitis from January 2011 to July 2017 in a tertiary hospital were retrospectively evaluated. The isolates were tested for antibiotic-resistance genes, virulence-associated genes, and molecular subtypes. Hyper-virulent K. pneumoniae (hvKP) was defined as the presence of pLVPK-like virulence plasmid.
Results:
During the study period, a total of 48 patients with meningitis caused by K. pneumoniae were identified, accounting for 21.2% (48/226) of Gram-negative bacilli meningitis. Of the 44 available isolates, 65.9% (29/44) were carbapenem resistant, and all except one har-bored bla KPC-2. K64 was the most common serotype (n=13), followed by K47 (n=11) and K1 (n=5). The pLVPK-related genetic loci were found in about half of isolates (iutA: 56.8%, iucA: 56.8%, rmpA2:50.0%, rmpA: 43.2%, and iroN: 40.9%). Twenty-two strains carrying pLVPK-derived virulence plasmid were defined as hvKP. Notably, the coexistence of bla KPC-2-encoding plasmid and the pLVPK-derived virulence plasmid was detected in 15 strains (34.1%, 15/44), suggesting K. pneumoniae carbapenemase-2 (KPC-2)-producing hvKP. The proportion of KPC-2-producing hvKP by year increased remarkably from 0% (2011) to 71.4% (2017). Of the 15 KPC-2-producing hvKP strains, 80.0% (12/15) were assigned to sequence type 11 and 2 strains (13.3%) belonged to clonal complex 23. Most of the patients infected with KPC-2-producing hvKP had preceding postneurosurgical state (93.3%, 14/15) and severe pneumonia (73.3%, 11/15). All the cases (100%, 15/15) had fatal outcome.
Conclusion:
The high prevalence and mortality of K. pneumoniae, especially KPC-2-producing hvKP meningitis, in China should be of concern. The implementation of epidemiological surveillance and identification of an effective clinical treatment are paramount.
Insights
Hypervirulent Klebsiella pneumoniae (hvKP) meningitis, particularly carbapenem-resistant strains, poses a significant threat in China. This study highlights the urgent need for surveillance and effective treatments due to high mortality rates.
Area of Science:
- Infectious Diseases
- Microbiology
- Epidemiology
Background:
- Klebsiella pneumoniae is a leading cause of adult bacterial meningitis in Asia.
- Clinical and microbiological data on K. pneumoniae meningitis in China were previously lacking.
Purpose of the Study:
- To investigate the clinical and microbiological characteristics of K. pneumoniae meningitis in mainland China.
- To identify risk factors and resistance patterns associated with K. pneumoniae meningitis.
Main Methods:
- Retrospective analysis of clinical data from patients with K. pneumoniae meningitis (2011-2017).
- Testing of isolates for antibiotic-resistance and virulence-associated genes.
- Definition of hypervirulent K. pneumoniae (hvKP) based on pLVPK-like virulence plasmid presence.
Main Results:
- 48 cases of K. pneumoniae meningitis identified; 65.9% of isolates were carbapenem-resistant, primarily harboring blaKPC-2.
- 34.1% of isolates were KPC-2-producing hvKP, with a significant increase from 2011 to 2017.
- KPC-2-producing hvKP meningitis cases had a 100% fatal outcome, often associated with post-neurosurgical state and severe pneumonia.
Conclusions:
- K. pneumoniae, especially KPC-2-producing hvKP, causes high-prevalence and high-mortality meningitis in China.
- Urgent implementation of epidemiological surveillance and development of effective treatments are crucial.
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