Co-occurrence of 3 different plasmids in an extensively drug-resistant hypervirulent Klebsiella pneumoniae isolate causing urinary tract infections.

Abstract Objectives A single carbapenem-resistant and hypervirulent Klebsiella pneumoniae strain attracts a major public concern. The aim of the present study was to better understand the antimicrobial resistance and the genetic characteristics of Klebsiella pneumoniae strain XJ-K1. Methods Klebsiella pneumoniae strain XJ-K1 was isolated from the urine specimen of a male patient aged 69 years in a teaching hospital, Shanghai, China, in Jan, 2018. Antimicrobial susceptibility testing, string test, whole genome sequencing (WGS), bioinformatics analysis and phylogenetic analysis were used in this study. Results Klebsiella pneumoniae strain XJ-K1 was an extensively drug-resistant hypervirulent, which showed high-level resistance to antibacterial agents. Three novel plasmids including a 207,409 bp IncHI1B-type rmpA2-bearing pLVPK-like virulence plasmid, a 130,628 bp Col156/IncFIB/IncFII-type aadA2, sul1, mph(A) and dfrA12-bearing MDR plasmid and a 99,408 bp IncFII/IncR-type blaKPC-2, blaTEM-1, blaCTX-M-65, blaSHV-12, rmtB and fosA3-bearing MDR plasmid, were discovered in the XJ-K1. The chromosome sequence analysis revealed the genes aadA2, fosA, and sul1 were located in the XJ-K1. Multilocus sequence typing results showed that XJ-K1 was defined as ST11. Conclusions A large number of resistance genes and a pLVPK-like virulence plasmid carried by strain XJ-K1 might the main reasons leading to extensively drug-resistant and hypervirulent. To the best of our knowledge, in China, this is the first report co-occurrence of one pLVPK-like virulence and two MDR plasmids in a single ST11 extensively drug-resistant hypervirulent Klebsiella pneumoniae strain isolated from the patient’s urine, which should be seriously concerned for its further outbreak.