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Assefa GM, Roberts JA, Aslan AT, Mohammed SA, Sime FB. A systematic review and individual bacterial species level meta-analysis of in vitro studies on the efficacy of ceftazidime/avibactam combined with other antimicrobials against carbapenem-resistant Gram-negative bacteria. J Antimicrob Chemother 2025; 80:334-346. [PMID: 39691958 PMCID: PMC11787894 DOI: 10.1093/jac/dkae451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2024] [Accepted: 12/02/2024] [Indexed: 12/19/2024] Open
Abstract
BACKGROUND Carbapenem-resistant Gram-negative bacteria (CR-GNB) develop resistance to many antimicrobials. To effectively manage infections caused by these organisms, novel agents and/or combinations of antimicrobials are required. OBJECTIVES Evaluated the in vitro efficacy of ceftazidime/avibactam in combination with other antimicrobials against CR-GNB. METHODS PubMed, Web of Science, Embase and Scopus were searched. Study outcomes were quantified by counting the number of isolates exhibiting synergy, defined as a fractional inhibitory concentration index ≤ 0.5 for checkerboard and Etest, and a >2 log cfu/mL reduction for time-kill studies. The proportion of synergy was calculated as the ratio of isolates exhibiting synergy to the total number of isolates tested. These proportions were analysed using a random-effects model, following the Freeman-Tukey double-arcsine transformation. RESULTS Forty-five in vitro studies were included. A total of 734 isolates were tested, and 69.3% of them were resistant to ceftazidime/avibactam. The combination of ceftazidime/avibactam with aztreonam showed a high synergy rate against carbapenem-resistant Klebsiella pneumoniae (effect size, ES = 0.91-0.98) and Escherichia coli (ES = 0.75-1.00). Ceftazidime/avibactam also demonstrated a high synergy rate (ES = 1) in time-kill studies when combined with azithromycin, fosfomycin and gentamicin against K. pneumoniae. Compared to ceftazidime/avibactam alone, a higher bactericidal rate was reported when ceftazidime/avibactam was combined with other antimicrobials against carbapenem-resistant K. pneumoniae (57% versus 31%) and E. coli (93% versus 0%). CONCLUSIONS Ceftazidime/avibactam frequently demonstrates synergistic bactericidal activity when combined with various antimicrobials against CR-GNB in in vitro tests. Further pre-clinical and clinical studies are warranted to validate the utility of ceftazidime/avibactam-based combination regimens for CR-GNB infections.
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Affiliation(s)
- Getnet M Assefa
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Jason A Roberts
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Pharmacy Department, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Department of Intensive Care Medicine, Royal Brisbane and Women’s Hospital, Brisbane, QLD, Australia
- Herston Infectious Disease Institute (HeIDI), Metro North Health, Brisbane, QLD, Australia
- Division of Anaesthesiology Critical Care Emerging and Pain Medicine, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Abdullah T Aslan
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Solomon A Mohammed
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Department of Pharmacy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Fekade B Sime
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Shapovalova VV, Chulkova PS, Ageevets VA, Nurmukanova V, Verentsova IV, Girina AA, Protasova IN, Bezbido VS, Sergevnin VI, Feldblum IV, Kudryavtseva LG, Sharafan SN, Semerikov VV, Babushkina ML, Valiullina IR, Chumarev NS, Isaeva GS, Belyanina NA, Shirokova IU, Mrugova TM, Belkova EI, Artemuk SD, Meltser AA, Smirnova MV, Akkonen TN, Golovshchikova NA, Goloshchapov OV, Chukhlovin AB, Popenko LN, Zenevich EY, Vlasov AA, Mitroshina GV, Bordacheva MS, Ageevets IV, Sulian OS, Avdeeva AA, Gostev VV, Tsvetkova IA, Yakunina MA, Vasileva EU, Matsvay AD, Danilov DI, Savochkina YA, Shipulin GA, Sidorenko SV. High-Risk Lineages of Hybrid Plasmids Carrying Virulence and Carbapenemase Genes. Antibiotics (Basel) 2024; 13:1224. [PMID: 39766615 PMCID: PMC11726917 DOI: 10.3390/antibiotics13121224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2024] [Revised: 12/09/2024] [Accepted: 12/16/2024] [Indexed: 01/15/2025] Open
Abstract
Background/Objectives: Carbapenem-resistant Enterobacterales (CRE) are a global health threat due to their high morbidity and mortality rates and limited treatment options. This study examines the plasmid-mediated transmission of virulence and antibiotic resistance determinants in carbapenem-resistant Klebsiella pneumoniae (Kpn) and Escherichia coli (E. coli) isolated from Russian hospitals. Methods: We performed short- and long-read whole-genome sequencing of 53 clinical isolates (48 Kpn and 5 E. coli) attributed to 15 genetic lineages and collected from 21 hospitals across nine Russian cities between 2016 and 2022. Results: The plasmid analysis identified 18 clusters that showed high concordance with replicon typing, with all clusters having a major replicon type. The majority of plasmids in the IncHI1B(pNDM-MAR)/IncFIB(pNDM-Mar)-like cluster (79.16%) carried both antibiotic resistance genes (e.g., blaNDM-1 and blaOXA-48) and virulence factors (VFs) such as siderophore genes. We hypothesized that hybrid plasmids could play a critical role in the dissemination of antibiotic resistance genes and VFs. Comparative analyses with global plasmid databases revealed high-risk lineages of hybrid plasmids that are predominantly spread throughout Russia at present. Conclusions: Our findings underscore the importance of monitoring plasmid backbones for clinical management, surveillance, and infection control activities.
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Affiliation(s)
- Valeria V. Shapovalova
- Centre for Strategic Planning, of the Federal Medical and Biological Agency, Moscow 119121, Russia; (V.N.); (A.D.M.); (D.I.D.); (Y.A.S.); (G.A.S.)
| | - Polina S. Chulkova
- Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia; (V.A.A.); (I.V.A.); (O.S.S.); (A.A.A.); (V.V.G.); (I.A.T.); (S.V.S.)
| | - Vladimir A. Ageevets
- Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia; (V.A.A.); (I.V.A.); (O.S.S.); (A.A.A.); (V.V.G.); (I.A.T.); (S.V.S.)
| | - Varvara Nurmukanova
- Centre for Strategic Planning, of the Federal Medical and Biological Agency, Moscow 119121, Russia; (V.N.); (A.D.M.); (D.I.D.); (Y.A.S.); (G.A.S.)
| | | | - Asya A. Girina
- Khanty-Mansiysk State Medical Academy, Khanty-Mansiysk 628011, Russia;
| | - Irina N. Protasova
- Department of Microbiology Named After Associate Professor B.M. Zelmanovich, Krasnoyarsk State Medical University Named After Professor V. F. Voyno-Yasenetsky, Krasnoyarsk 660022, Russia;
| | - Victoria S. Bezbido
- Krasnoyarsk Interdistrict Clinical Emergency Hospital Named After N.S. Karpovich, Krasnoyarsk 660062, Russia;
| | - Victor I. Sergevnin
- Department of Epidemiology and Hygiene, Perm State Medical University Named After Academician E.A. Wagner, Perm 614000, Russia; (V.I.S.); (I.V.F.)
| | - Irina V. Feldblum
- Department of Epidemiology and Hygiene, Perm State Medical University Named After Academician E.A. Wagner, Perm 614000, Russia; (V.I.S.); (I.V.F.)
| | - Larisa G. Kudryavtseva
- Federal Center for Cardiovascular Surgery Named After S.G. Sukhanov of the Ministry of Health of the Russian Federation, Perm 614013, Russia; (L.G.K.); (S.N.S.)
| | - Sergey N. Sharafan
- Federal Center for Cardiovascular Surgery Named After S.G. Sukhanov of the Ministry of Health of the Russian Federation, Perm 614013, Russia; (L.G.K.); (S.N.S.)
| | - Vladislav V. Semerikov
- State Budgetary Healthcare Institution of Perm Krai «Perm Regional Clinical Infectious Diseases Hospital», Perm 614014, Russia; (V.V.S.); (M.L.B.)
| | - Marina L. Babushkina
- State Budgetary Healthcare Institution of Perm Krai «Perm Regional Clinical Infectious Diseases Hospital», Perm 614014, Russia; (V.V.S.); (M.L.B.)
| | - Inna R. Valiullina
- Republican Clinical Hospital of the Ministry of Health of the Republic of Tatarstan, Kazan 420064, Russia;
| | - Nikita S. Chumarev
- Department of Microbiology Named After Academician V.M. Aristovsky, Kazan State Medical University of the Ministry of Health of the Russian Federation, Kazan 420012, Russia; (N.S.C.); (G.S.I.)
| | - Guzel S. Isaeva
- Department of Microbiology Named After Academician V.M. Aristovsky, Kazan State Medical University of the Ministry of Health of the Russian Federation, Kazan 420012, Russia; (N.S.C.); (G.S.I.)
- Kazan Scientific Research Institute of Epidemiology and Microbiology, Kazan 420015, Russia
| | - Natalya A. Belyanina
- Department of Epidemiology, Microbiology and Evidence-Based Medicine, Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation (FSBEI HE PRMU MOH Russia), Nizhny Novgorod 603005, Russia; (N.A.B.); (I.U.S.)
| | - Irina U. Shirokova
- Department of Epidemiology, Microbiology and Evidence-Based Medicine, Federal State Budgetary Educational Institution of Higher Education «Privolzhsky Research Medical University» of the Ministry of Health of the Russian Federation (FSBEI HE PRMU MOH Russia), Nizhny Novgorod 603005, Russia; (N.A.B.); (I.U.S.)
| | - Tatiana M. Mrugova
- State Budgetary Institution of Healthcare of the City of Moscow «Moscow Science and Practical Centre for the Laboratory Research of the Department of Healthcare of the City of Moscow», Moscow 127015, Russia;
| | - Elena I. Belkova
- Mariinsky Hospital, Saint Petersburg 191014, Russia; (E.I.B.); (S.D.A.); (A.A.M.); (M.V.S.)
| | - Svetlana D. Artemuk
- Mariinsky Hospital, Saint Petersburg 191014, Russia; (E.I.B.); (S.D.A.); (A.A.M.); (M.V.S.)
| | - Aleksandra A. Meltser
- Mariinsky Hospital, Saint Petersburg 191014, Russia; (E.I.B.); (S.D.A.); (A.A.M.); (M.V.S.)
| | - Marina V. Smirnova
- Mariinsky Hospital, Saint Petersburg 191014, Russia; (E.I.B.); (S.D.A.); (A.A.M.); (M.V.S.)
| | - Tatyana N. Akkonen
- City Polyclinic No. 74, Saint Petersburg 197762, Russia; (T.N.A.); (N.A.G.)
| | | | - Oleg V. Goloshchapov
- R. M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov University, Saint Petersburg 197022, Russia; (O.V.G.); (A.B.C.)
| | - Alexey B. Chukhlovin
- R. M. Gorbacheva Memorial Institute of Oncology, Hematology and Transplantation, Pavlov University, Saint Petersburg 197022, Russia; (O.V.G.); (A.B.C.)
| | - Lubov N. Popenko
- I. I. Dzhanelidze Research Institute of Emergency Medical Service, Saint Petersburg 192242, Russia;
| | | | - Aleksandr A. Vlasov
- Psychiatric Hospital No. 1 Named After P. P. Kaschenko, Saint Petersburg 195009, Russia;
| | - Galina V. Mitroshina
- Napalkov State Budgetary Healthcare Institution “Saint-Petersburg Clinical Scientific and Practical Center for Specialised Types of Medical Care (Oncological)”, Saint Petersburg 197101, Russia; (G.V.M.); (M.S.B.)
| | - Marina S. Bordacheva
- Napalkov State Budgetary Healthcare Institution “Saint-Petersburg Clinical Scientific and Practical Center for Specialised Types of Medical Care (Oncological)”, Saint Petersburg 197101, Russia; (G.V.M.); (M.S.B.)
| | - Irina V. Ageevets
- Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia; (V.A.A.); (I.V.A.); (O.S.S.); (A.A.A.); (V.V.G.); (I.A.T.); (S.V.S.)
| | - Ofeliia S. Sulian
- Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia; (V.A.A.); (I.V.A.); (O.S.S.); (A.A.A.); (V.V.G.); (I.A.T.); (S.V.S.)
| | - Alisa A. Avdeeva
- Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia; (V.A.A.); (I.V.A.); (O.S.S.); (A.A.A.); (V.V.G.); (I.A.T.); (S.V.S.)
| | - Vladimir V. Gostev
- Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia; (V.A.A.); (I.V.A.); (O.S.S.); (A.A.A.); (V.V.G.); (I.A.T.); (S.V.S.)
- Department of Medical Microbiology, North-Western State Medical University Named After I.I. Mechnikov, Saint Petersburg 191015, Russia
| | - Irina A. Tsvetkova
- Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia; (V.A.A.); (I.V.A.); (O.S.S.); (A.A.A.); (V.V.G.); (I.A.T.); (S.V.S.)
| | - Maria A. Yakunina
- Murmansk Regional Clinical-Hospital Named After P.A. Bayandin, Murmasnk 183047, Russia; (M.A.Y.); (E.U.V.)
| | - Ekaterina U. Vasileva
- Murmansk Regional Clinical-Hospital Named After P.A. Bayandin, Murmasnk 183047, Russia; (M.A.Y.); (E.U.V.)
| | - Alina D. Matsvay
- Centre for Strategic Planning, of the Federal Medical and Biological Agency, Moscow 119121, Russia; (V.N.); (A.D.M.); (D.I.D.); (Y.A.S.); (G.A.S.)
| | - Dmitry I. Danilov
- Centre for Strategic Planning, of the Federal Medical and Biological Agency, Moscow 119121, Russia; (V.N.); (A.D.M.); (D.I.D.); (Y.A.S.); (G.A.S.)
| | - Yulia A. Savochkina
- Centre for Strategic Planning, of the Federal Medical and Biological Agency, Moscow 119121, Russia; (V.N.); (A.D.M.); (D.I.D.); (Y.A.S.); (G.A.S.)
| | - German A. Shipulin
- Centre for Strategic Planning, of the Federal Medical and Biological Agency, Moscow 119121, Russia; (V.N.); (A.D.M.); (D.I.D.); (Y.A.S.); (G.A.S.)
| | - Sergey V. Sidorenko
- Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg 197022, Russia; (V.A.A.); (I.V.A.); (O.S.S.); (A.A.A.); (V.V.G.); (I.A.T.); (S.V.S.)
- Department of Medical Microbiology, North-Western State Medical University Named After I.I. Mechnikov, Saint Petersburg 191015, Russia
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Han X, Yao J, He J, Liu H, Jiang Y, Zhao D, Shi Q, Zhou J, Hu H, Lan P, Zhou H, Li X. Clinical and laboratory insights into the threat of hypervirulent Klebsiella pneumoniae. Int J Antimicrob Agents 2024; 64:107275. [PMID: 39002700 DOI: 10.1016/j.ijantimicag.2024.107275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/15/2024] [Accepted: 07/06/2024] [Indexed: 07/15/2024]
Abstract
Hypervirulent Klebsiella pneumoniae (hvKP) typically causes severe invasive infections affecting multiple sites in healthy individuals. In the past, hvKP was characterized by a hypermucoviscosity phenotype, susceptibility to antimicrobial agents, and its tendency to cause invasive infections in healthy individuals within the community. However, there has been an alarming increase in reports of multidrug-resistant hvKP, particularly carbapenem-resistant strains, causing nosocomial infections in critically ill or immunocompromised patients. This presents a significant challenge for clinical treatment. Early identification of hvKP is crucial for timely infection control. Notably, identifying hvKP has become confusing due to its prevalence in nosocomial settings and the limited predictive specificity of the hypermucoviscosity phenotype. Novel virulence predictors for hvKP have been discovered through animal models or machine learning algorithms, while standardization of identification criteria is still necessary. Timely source control and antibiotic therapy have been widely employed for the treatment of hvKP infections. Additionally, phage therapy is a promising alternative approach due to escalating antibiotic resistance. In summary, this narrative review highlights the latest research progress in the development, virulence factors, identification, epidemiology of hvKP, and treatment options available for hvKP infection.
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Affiliation(s)
- Xinhong Han
- Department of Clinical Laboratory, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang, China
| | - Jiayao Yao
- Centre of Laboratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Jintao He
- Department of Infectious Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haiyang Liu
- Centre of Laboratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yan Jiang
- Department of Infectious Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Dongdong Zhao
- Department of Infectious Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Qiucheng Shi
- Department of Infectious Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Junxin Zhou
- Department of Infectious Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Huangdu Hu
- Department of Infectious Diseases, Centre for General Practice Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Peng Lan
- Department of Infectious Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China; Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province, Hangzhou, Zhejiang, China; Regional Medical Center for National Institute of Respiratory Diseases, Sir Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hua Zhou
- Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
| | - Xi Li
- Centre of Laboratory Medicine, Zhejiang Provincial People's Hospital, People's Hospital of Hangzhou Medical College, Hangzhou, Zhejiang, China.
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Ye M, Liu L, Liu B, Zhou X, Li Q. Drug Resistance and Molecular Characteristics of Carbapenem-Resistant OXA-48-Producing Klebsiella pneumoniae Strains in Hainan, China. Microorganisms 2023; 12:49. [PMID: 38257876 PMCID: PMC10820085 DOI: 10.3390/microorganisms12010049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 12/11/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND The emergence and global spread of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) are of great concern to health services worldwide. These β-lactamases hydrolyze almost all β-lactams, are plasmid-encoded, and are easily transferable among bacterial species. They are mostly of the KPC types in CR-hvKp. OXA-48-producing hvKP strains have been rarely reported in the literature. METHODS OXA-48-producing hvKP strains were collected from clinical specimens at the First Affiliated Hospital of Hainan Medical University from January 2022 to March 2023. Hypervirulent strains were tested for virulence in a mouse lethality study and underwent whole genome sequencing to identify genomic features. RESULTS A total of 42 unique OXA-48-bearing K. pneumoniae strains were identified, including three CR-hvKP strains (KP2683-1, NCRE61, and KP2185), which were isolated from bacteremia, pulmonary abscess, and liver abscess separately. The three CR-hvKP strains belonged to two different clones of ST11 KL64 (KP2185 and NCRE61) and ST23 K1 (KP2683-1). The KP2683-1 strain had the highest virulence. Whole genome sequencing analysis indicated that NCRE61 and KP2185 acquired IncFIB-type plasmids with a set of virulence genes (iroBCDN, iucABCD, iutA, rmpA, and rmpA2), while KP2683-1 acquired an IncL-type blaOXA-48-harboring plasmid. Consecutive cultures showed that the blaOXA-48-harboring plasmids were highly stable in the three hvKP strains and could be transmitted to Escherichia coli J53 by conjugation. The drug susceptibility testing results show that Ceftazidime/avibactam is sensitive for OXA-48-producing hvKP. CONCLUSIONS Our study highlighted the two evolutionary pathways of OXA-48-producing hvKP strains and confirmed their virulence through in vivo testing. Ceftazidime/avibactam may be a viable option for treating OXA-48-producing hvKP strains.
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Affiliation(s)
- Min Ye
- International School of Nursing, Hainan Medical University, Haikou 571199, China;
- Department of Respiratory Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou 570100, China; (L.L.); (B.L.)
- Hainan Province Clinical Medical Center of Respiratory Disease, Haikou 579199, China
| | - Lei Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou 570100, China; (L.L.); (B.L.)
- Hainan Province Clinical Medical Center of Respiratory Disease, Haikou 579199, China
- NHC Key Laboratory of Tropical Disease Control, Hainan Medical University, Haikou 571199, China
| | - Bin Liu
- Department of Respiratory Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou 570100, China; (L.L.); (B.L.)
- Hainan Province Clinical Medical Center of Respiratory Disease, Haikou 579199, China
- NHC Key Laboratory of Tropical Disease Control, Hainan Medical University, Haikou 571199, China
| | - Xiangdong Zhou
- Department of Respiratory Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou 570100, China; (L.L.); (B.L.)
- Hainan Province Clinical Medical Center of Respiratory Disease, Haikou 579199, China
- NHC Key Laboratory of Tropical Disease Control, Hainan Medical University, Haikou 571199, China
| | - Qi Li
- Department of Respiratory Medicine, The First Affiliated Hospital of Hainan Medical University, Haikou 570100, China; (L.L.); (B.L.)
- Hainan Province Clinical Medical Center of Respiratory Disease, Haikou 579199, China
- NHC Key Laboratory of Tropical Disease Control, Hainan Medical University, Haikou 571199, China
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