Emergence of carbapenem-resistant putative hypervirulent <i>Klebsiella pneumoniae</i> ST147 with a distinct hybrid plasmid in Türkiye.
The proportion of carbapenem-resistant hypervirulent Klebsiella pneumoniae in Türkiye rose from 20.7% to 33.1% between 2018 and 2023, with a notable shift to ST147 as the dominant lineage.
Where it sits
this study against the rest of the ghrp-2 (pralmorelin) corpusSummary and findings
This study measured the emergence of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) in Türkiye from 2018 to 2023. The proportion of CR-hvKp among CR-Kp increased from 20.7% in 2018 to 33.1% by 2023. A shift from ST2096 to ST147 as the dominant lineage was observed, with ST147 characterized by specific resistance genes.
Abstract
Carbapenem-resistant hypervirulent <i>Klebsiella pneumoniae</i> (CR-hvKp) represents a growing clinical threat due to convergence of resistance and virulence determinants. We conducted a multicenter genomic epidemiology study analysing CR-hvKp isolates collected from 19 tertiary-care hospitals across Türkiye between 2018 and 2023. CR-hvKp isolates were subjected to whole-genome sequencing to investigate resistance and virulence determinants, plasmid replicon profiles, and phylogenetic relationships. The proportion of CR-hvKp among CR-Kp increased from 20.7% in 2018 to 33.1% by 2023. We identified ST2096 as the predominant clone in 2018-2019, largely associated with <i>bla</i><sub>OXA-232</sub>. However, after 2022, ST147 emerged as the dominant CR-hvKp lineage, characterized by co-carriage of <i>bla</i><sub>NDM-5</sub> and <i>bla</i><sub>OXA-48</sub>, KL64 capsule, and exhibiting high antimicrobial resistance scores. Long-read sequencing revealed a 364-kb hybrid plasmid in an ST147 isolate, harbouring IncHI1B_pNDM and IncFIB_pNDM replicons. Notably, the ST147 hybrid plasmid (pPF302_hybrid) carried <i>rmtF1</i> and <i>arr-2</i>, resistance genes that have not been previously reported in hybrid plasmids linked to ST147. These findings indicate ongoing acquisition of resistance determinants in ST147 and highlight its increased adaptive potential under antimicrobial pressure. Our results demonstrate a clear clonal shift in Türkiye's CR-hvKp population from ST2096 to ST147, alongside evolving resistance patterns and the emergence of hybrid plasmids. These insights emphasise the need for ongoing genomic surveillance and robust molecular characterisation in regions facing high CR-hvKp prevalence.
Background
The study addresses the clinical threat posed by carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp), which combines resistance and virulence factors. Prior knowledge indicated a rise in such pathogens, but the specific dynamics in Türkiye had not been comprehensively analyzed. This study is significant as it provides insights into the changing epidemiology of CR-hvKp in a multi-center context over several years.
Methods
This multicenter genomic epidemiology study analyzed CR-hvKp isolates from 19 tertiary-care hospitals in Türkiye between 2018 and 2023. Whole-genome sequencing was performed to investigate resistance and virulence determinants, plasmid profiles, and phylogenetic relationships. The study design included a longitudinal analysis of isolates collected over five years.
Results
The proportion of CR-hvKp among CR-Kp increased from 20.7% in 2018 to 33.1% by 2023. The predominant clone shifted from ST2096 in 2018-2019 to ST147 after 2022, with ST147 exhibiting co-carriage of blaNDM-5 and blaOXA-48. The study also identified a 364-kb hybrid plasmid in an ST147 isolate, which carried novel resistance genes rmtF1 and arr-2.
Interpretation
The findings indicate a significant shift in the CR-hvKp population in Türkiye, with ST147 becoming the dominant lineage. While the increase in CR-hvKp is statistically significant, the clinical implications of this shift require further investigation to determine the impact on patient outcomes. Limitations include the potential for confounding factors such as regional antimicrobial use and the study's reliance on genomic data without clinical correlation.
Key findings
- Proportion of CR-hvKp among CR-Kp increased from 20.7% in 2018 to 33.1% by 2023.
- ST2096 was predominant in 2018-2019, associated with blaOXA-232.
- ST147 emerged as the dominant lineage after 2022, characterized by co-carriage of blaNDM-5 and blaOXA-48.
- A 364-kb hybrid plasmid was identified in an ST147 isolate.
- The hybrid plasmid carried rmtF1 and arr-2, resistance genes not previously reported in ST147.
Limitations
- Not reported in abstract.
- Multi-center study but limited to Türkiye.
- Focus on genomic data without clinical correlation.
- Potential confounding factors not addressed.