Hypervirulence and carbapenem resistance: two distinct evolutionary directions that led high-risk Klebsiella pneumoniae clones to epidemic success
Journal
Expert Review of Molecular Diagnostics
Journal Volume
19
Journal Issue
9
Pages
825-837
Date Issued
2019
Author(s)
Abstract
Introduction: Over the past few decades, Klebsiella pneumoniae has become a significant threat to public health and is now listed as an ESKAPE pathogen. Evolving with versatile capabilities, K. pneumoniae is a population composed of genetically and phenotypically diverse bacteria. However, epidemic K. pneumoniae are restricted to specific clonal lineages. The clonal group CG23 comprises hypervirulent K. pneumoniae displaying limited resistance to antimicrobials and is frequently associated with the community-acquired invasive syndrome. On the other hand, CG258 is another clonal group of K. pneumoniae that has evolved resistance to carbapenems, primarily by acquiring the carbapenemase-encoding genes through nosocomial carriage. Areas covered: With a focus on the high-risk K. pneumoniae clonal lineages CG23 and CG258, we review recent advances including the newly discovered lineage-specific genomic features, and the molecular basis of K. pneumoniae-associated epidemiology, antimicrobial resistance, and hypervirulence. Expert opinion: Both CG23 and CG258 can establish reservoirs in susceptible individuals. Empirical antimicrobial regimens that are prescribed for immediate treatments frequently create selective pressures that favor the high-risk lineages to develop into prominent colonizers. This dilemma reinforces the need for effective therapies that require rapid and accurate diagnosis of epidemic K. pneumoniae. ? 2019, ? 2019 Informa UK Limited, trading as Taylor & Francis Group.
SDGs
Other Subjects
carbapenem; colibactin; nonribosomal peptide synthetase; siderophore; unclassified drug; virulence plasmid; antiinfective agent; bacterial protein; beta lactamase; carbapenem derivative; carbapenemase; antibiotic resistance; antibiotic resistome; bacterial virulence; bla kpc gene; carbapenem resistance; clinical feature; clonal variation; diagnostic accuracy; epidemic; gene; gene insertion sequence; genetic code; genetic variation; hospital infection; human; Klebsiella pneumoniae; Klebsiella pneumoniae infection; mobile genetic element; multidrug resistant Klebsiella pneumoniae; pandemic; Review; risk factor; whole genome sequencing; community acquired infection; drug effect; genetics; Klebsiella infection; Klebsiella pneumoniae; metabolism; microbiology; molecular epidemiology; multidrug resistance; pathology; plasmid; virulence; Anti-Bacterial Agents; Bacterial Proteins; beta-Lactamases; Carbapenems; Community-Acquired Infections; Drug Resistance, Multiple, Bacterial; Humans; Klebsiella Infections; Klebsiella pneumoniae; Molecular Epidemiology; Plasmids; Virulence
Type
review