Nosocomial transmission, adaption and clinical outcomes of carbapenem-resistant hypervirulent Klebsiella pneumoniae

Background Carbapenem-resistant hypervirulent  Klebsiella pneumoniae  (CR-HvKp) poses a significant threat in healthcare settings. This study investigates the nosocomial transmission dynamics, adaptive phenotypes, and clinical outcomes of CR-HvKp with different evolutionary patterns. Methods A genom...

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Published in:BMC microbiology Vol. 25; no. 1; pp. 376 - 15
Main Authors: Liu, Yanjun, Wang, Zhiqian, Jian, Zijuan, Liu, Peilin, Li, Yanming, Qin, Fang, Yan, Qun, Liu, Wenen
Format: Journal Article
Language:English
Published: London BioMed Central 02.07.2025
BioMed Central Ltd
Springer Nature B.V
BMC
Subjects:
Adaptation
Aged
Anti-Bacterial Agents - pharmacology
Antibiotics
Antigens
Antimicrobial agents
Bacteria
Biofilms
Biological Microscopy
Biomedical and Life Sciences
Carbapenem-Resistant Enterobacteriaceae - drug effects
Carbapenem-Resistant Enterobacteriaceae - genetics
Carbapenem-Resistant Enterobacteriaceae - isolation & purification
Carbapenem-Resistant Enterobacteriaceae - pathogenicity
Carbapenem-resistant hypervirulent Klebsiella pneumoniae
Carbapenems
Carbapenems - pharmacology
Care and treatment
China - epidemiology
Clinical outcomes
Competitiveness
Control
Cross infection
Cross Infection - epidemiology
Cross Infection - microbiology
Cross Infection - transmission
Diagnosis
Disease transmission
Drug resistance
Electronic health records
Electronic medical records
Epidemiology
Evolution & development
Evolutionary patterns
Female
Genes
Genomes
Genomic analysis
Hospitals
Humans
Identification and classification
Infections
Intensive Care Units
Klebsiella
Klebsiella Infections - drug therapy
Klebsiella Infections - epidemiology
Klebsiella Infections - microbiology
Klebsiella Infections - mortality
Klebsiella Infections - transmission
Klebsiella pneumoniae
Klebsiella pneumoniae - classification
Klebsiella pneumoniae - drug effects
Klebsiella pneumoniae - genetics
Klebsiella pneumoniae - isolation & purification
Klebsiella pneumoniae - pathogenicity
Laboratory animals
Life Sciences
Male
Maximum likelihood method
Microbial Sensitivity Tests
Microbiology
Middle Aged
Mortality
Mycology
Neutrophils
Nosocomial infection
Nosocomial infections
Nosocomial transmission
Parasitology
Phenotypes
Phylogenetics
Plasmids
Prevention
Retrospective Studies
Risk factors
Sepsis
Septic shock
Virology
Virulence
China
Nosocomial transmission
Carbapenem-resistant hypervirulent
Evolutionary patterns
Clinical outcomes
Adaptation
Carbapenem-resistant hypervirulent Klebsiella pneumoniae
ISSN:1471-2180, 1471-2180
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Summary:Background Carbapenem-resistant hypervirulent  Klebsiella pneumoniae  (CR-HvKp) poses a significant threat in healthcare settings. This study investigates the nosocomial transmission dynamics, adaptive phenotypes, and clinical outcomes of CR-HvKp with different evolutionary patterns. Methods A genomic analysis of 2,002  Klebsiella pneumoniae  isolates collected from a major teaching hospital in China was performed to identify convergent isolates. Epidemiological features, including CR-HvKp nosocomial transmission, were assessed. Selected isolates underwent phenotypic testing to evaluate adaptive traits. Clinical outcomes were analyzed retrospectively using electronic medical records. Results A total of 127 CR-HvKp were characterized, with ST11-KL64 hv-CRKP (carbapenem resistant  Klebsiella pneumoniae  acquired hypervirulence) as the predominant sequence type. CR-HvKp exhibited diverse evolutionary patterns linked to nosocomial transmission, particularly in the ICU. ST11-KL64 hv-CRKP demonstrated robust transmission within ICU settings. Compared to CRKP, hv-CRKP showed enhanced in vitro competitiveness and superior immune evasion. CR-HvKp infections were significantly associated with higher mortality rates, especially involved in sepsis or septic shock ( P  < 0.0001). Conclusion The ST11-KL64 hv-CRKP clonal complex is highly prevalent in CR-HvKp and demonstrates significant nosocomial transmission, particularly within ICU settings. Timely and effective sepsis management is critical to improving survival outcomes in CR-HvKp infections. Continuous genomic surveillance is imperative to control the spread of these pathogens.
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ISSN:1471-2180
1471-2180
DOI:10.1186/s12866-025-04096-z