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Testing the Role of Multicopy Plasmids in the Evolution of Antibiotic Resistance
Published on: May 2, 2018
Klebsiella pneumoniae with Two Carbapenemases: Where Molecular Research Stands Now
Qian Yu1, Gaosha Li1, Qianqian Xu2
1Department of Clinical Laboratory, Affiliated Jinhua Hospital, Zhejiang University School of Medicine (Jinhua Municipal Central Hospital), Jinhua, Zhejiang, People's Republic of China.
Abstract:
Klebsiella pneumoniae is a significant pathogen causing various infections. Since the 1990s, carbapenem-resistant Klebsiella pneumoniae (CRKP) has threatened global health. Its main resistance mechanism is producing carbapenemases like KPC, NDM, OXA, IMP and VIM, which have different prevalent isoforms and resistance features. In China, KPC is the most common carbapenemase in CRKP, followed by metallo-β-lactamase (MBL). Alarmingly, an increasing number of K. pneumoniae strains carry two or more types of enzymes, making resistance more complex. This review summarizes the major carbapenemases carried by K. pneumoniae, their global spread, and plasmids of CRKP enzyme type combinations reported in existing studies. Common combinations such as KPC + metalloenzyme, bimetallic enzyme, and metalloenzyme + OXA-48 are discussed in detail, including their genetic environments and transfer characteristics. Whole genome sequencing technology plays a crucial role in studying drug resistance genes of K. pneumoniae, facilitating in - depth identification and analysis of bacteria, and being useful for outbreak investigation and epidemiological surveillance. In conclusion, resistance genes in K. pneumoniae are often located on mobile elements. Different resistance genes tend to be carried by specific plasmids, which have high transformation rates and little impact on host growth. In order to prevent the emergence of Klebsiella pneumoniae carrying multiple drug-resistant genes, several measures such as the rational use of antibiotics, earlier monitoring of the transmission trajectory of strains, and the prediction of the development direction of drug resistance as much as possible are particularly important in the world today.
Insights
Carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a global threat due to carbapenemase enzymes. Understanding enzyme combinations and mobile genetic elements is crucial for combating CRKP infections and antimicrobial resistance.
Area of Science:
- Microbiology
- Infectious Diseases
- Genetics
Background:
- Klebsiella pneumoniae is a major cause of hospital-acquired infections.
- Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as a significant global health concern since the 1990s.
- Carbapenemase production is the primary mechanism of resistance in CRKP.
Purpose of the Study:
- To review major carbapenemases in Klebsiella pneumoniae.
- To summarize global spread and plasmid-mediated co-occurrence of carbapenemase genes.
- To discuss genetic environments and transfer characteristics of common CRKP enzyme combinations.
Main Methods:
- Literature review of studies on carbapenemases in Klebsiella pneumoniae.
- Analysis of reported CRKP enzyme type combinations and their plasmids.
- Discussion of whole genome sequencing's role in resistance gene identification.
Main Results:
- KPC is the most prevalent carbapenemase in China, followed by metallo-beta-lactamases (MBLs).
- Increasing CRKP strains exhibit multiple carbapenemase types, complicating resistance.
- Common combinations include KPC + MBL, bimetallic enzymes, and MBL + OXA-48, often on mobile genetic elements like plasmids.
Conclusions:
- Resistance genes in Klebsiella pneumoniae are frequently located on mobile genetic elements, particularly plasmids.
- Plasmids carrying multiple resistance genes exhibit high transfer rates with minimal host impact.
- Preventing multi-drug resistant Klebsiella pneumoniae requires rational antibiotic use, early surveillance, and resistance trend prediction.
