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Background <p>Carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) presents a significant public health challenge globally, particularly due to the emergence of lineages with hypervirulent traits. Despite considerable impacts, the genomic epidemiology and evolutionary dynamics of CRKP, including classical CRKP, carbapenem-resistant hypervirulent <i>K. pneumoniae</i> (CR-hvKP), and hypervirulent carbapenem-resistant <i>K. pneumoniae</i> (hv-CRKP), remain poorly understood.</p> Methods <p>We performed a retrospective genomic epidemiology analysis on 131 CRKP isolates collected from a tertiary teaching hospital in Zhejiang Province, China, from 2010 to 2025. All isolates were subjected to antimicrobial susceptibility testing and whole-genome sequencing, followed by phylogenetic analysis and comprehensive characterization of resistance genes, virulence factors, and mobile genetic elements (MGEs).</p> Results <p>Phylogenetic analysis revealed 23 sequence types (STs), with ST11 (50.38%), ST15 (17.56%), and ST23 (7.63%) predominating. Nearly half (49.62%) of these isolates were hypervirulent, subdivided into 15 CR-hvKP (mainly ST23, predominant in 2013-2017) and 50 hv-CRKP isolates (mainly ST11, predominant since 2019). The hv-CRKP isolates exhibited cross-ward hospital dissemination capabilities superior to CR-hvKP strains. Additionally, hv-CRKP demonstrated resistance profiles comparable to classical CRKP but higher resistance rates to aminoglycosides, fluoroquinolones, and tetracyclines than CR-hvKP. Genetic analyses revealed substantial diversity in resistance genes, virulence factors, and MGEs among these CRKP lineages. The hv-CRKP strains notably carried a higher load of prophages and plasmids compared to classical CRKP and CR-hvKP, suggesting an expanded genomic repertoire that may enhance their evolutionary adaptability.</p> Conclusions <p>Our findings underscore the adaptive evolution and increasing dominance of hv-CRKP within hospital settings, highlighting the urgent need for intensified surveillance and intervention strategies to curb the spread of these highly virulent and resistant pathogens.</p>

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Emergence and hospital dissemination of hypervirulent carbapenem-resistant Klebsiella pneumoniae lineages in eastern China

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年12月28日

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  • Wangxiao Zhou,
  • Ting Yang,
  • Jing Zhou,
  • Kongliang Huang,
  • Yushu Zheng,
  • Chengsi Jiang,
  • Yongan Ji,
  • Deru Lei,
  • Caixia Liu

摘要

Background

Carbapenem-resistant Klebsiella pneumoniae (CRKP) presents a significant public health challenge globally, particularly due to the emergence of lineages with hypervirulent traits. Despite considerable impacts, the genomic epidemiology and evolutionary dynamics of CRKP, including classical CRKP, carbapenem-resistant hypervirulent K. pneumoniae (CR-hvKP), and hypervirulent carbapenem-resistant K. pneumoniae (hv-CRKP), remain poorly understood.

Methods

We performed a retrospective genomic epidemiology analysis on 131 CRKP isolates collected from a tertiary teaching hospital in Zhejiang Province, China, from 2010 to 2025. All isolates were subjected to antimicrobial susceptibility testing and whole-genome sequencing, followed by phylogenetic analysis and comprehensive characterization of resistance genes, virulence factors, and mobile genetic elements (MGEs).

Results

Phylogenetic analysis revealed 23 sequence types (STs), with ST11 (50.38%), ST15 (17.56%), and ST23 (7.63%) predominating. Nearly half (49.62%) of these isolates were hypervirulent, subdivided into 15 CR-hvKP (mainly ST23, predominant in 2013-2017) and 50 hv-CRKP isolates (mainly ST11, predominant since 2019). The hv-CRKP isolates exhibited cross-ward hospital dissemination capabilities superior to CR-hvKP strains. Additionally, hv-CRKP demonstrated resistance profiles comparable to classical CRKP but higher resistance rates to aminoglycosides, fluoroquinolones, and tetracyclines than CR-hvKP. Genetic analyses revealed substantial diversity in resistance genes, virulence factors, and MGEs among these CRKP lineages. The hv-CRKP strains notably carried a higher load of prophages and plasmids compared to classical CRKP and CR-hvKP, suggesting an expanded genomic repertoire that may enhance their evolutionary adaptability.

Conclusions

Our findings underscore the adaptive evolution and increasing dominance of hv-CRKP within hospital settings, highlighting the urgent need for intensified surveillance and intervention strategies to curb the spread of these highly virulent and resistant pathogens.