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Emergence and molecular evolution of carbapenem-resistant hypervirulent ST23 Klebsiella pneumoniae: The superbug
Tao Chen1, Xueting Wang1, Luying Xiong1
1State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, National Clinical Research Center for Infectious Diseases, China-Singapore Belt and Road Joint Laboratory on Infection Research and Drug Development, National Medical Center for Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
Abstract:
This study aimed to investigate the molecular epidemiology of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) ST23 in China. We conducted comprehensive searches across five databases (PubMed, Web of Science, MEDLINE, CNKI, and Wanfang) spanning 1980-2024, identifying 30 eligible studies through rigorous screening. Our synthesis documents 120 ST23 CR-hvKP clinical isolates, including the earliest known case from Zhejiang in 2013 which harbored blaKPC-2 alongside hallmark virulence loci (rmpA, rmpA2, iroN, iucA, and pagO). Epidemiological analysis of 119 isolates reveals geographic disparities: Hebei (25.2%) and Jiangxi (22.7%) are hotspots, while carbapenemase distribution exhibits a north-south divide (blaNDM predominating in northern China versus blaKPC in the south). Phylogenetic analysis of 584 global ST23 genomes suggests independent plasmid-mediated acquisition of carbapenemase genes, with evidence of clonal transmission both among humans and between humans and environmental niches. This review highlights the urgent need for surveillance to track CR-hvKP's evolving epidemiology, alongside interventions targeting plasmid-driven resistance spread.
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