Abstract
BACKGROUND: Infections caused by carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-HVKP) pose a critical challenge in clinical management due to limited treatment options and high mortality. Elucidating their virulence determinants and resistance mechanisms is essential for optimizing antimicrobial strategies and improving patient outcomes. METHODS: We conducted a retrospective analysis of 102 carbapenem-resistant CRKP strains. Antimicrobial susceptibility testing was performed using the broth microdilution method, and resistance genotypes were characterized via PCR and Sanger sequencing. Virulence factors were identified through genomic sequencing and validated in a murine survival model (n = 6 mice per strain). Conjugation assays were performed to assess the transferability of resistance and virulence genes, with recipient strain E. coli J53, and transfer events were confirmed by PCR. RESULTS: CRKP strains were predominantly derived from sputum-, urine- and blood-specimens. Patients with CRKP infections predominantly had pulmonary infections. CRKP exhibited high resistance to other β-lactam antibiotics, mainly due to the presence of bla(KPC-2), high resistance to quinolones mediated by the carriage of aac (6''-Ib-cr), QnrS and QnrB, and high resistance to aminoglycosides mediated by the carriage of rmtB, ant(3'')-I and armA. CR-HVKP is mainly composed of ST11. Aerobactin (iucA, iutA), Ent siderophore (fepA, entB), Salmochelin (iroN), Yersiniabactin (ybtS), Type 3 fimbriae (mrkD), Type I fimbriae (fimH), and Regulation ((p)rmpA) were detected in the CR-HVKP isolates. The CR-HVKP strains had a median lethal dose (LD(50)) of 2 × 10(3) to 5 × 10(3) CFU in the mice, which was similar to that of the positive control NTUH-K2044. Conjugation assays revealed that the genes iucA, iutA, iroN, (p)rmpA, bla(KPC-2), bla(NDM-1), bla(VIM), bla(SHV-12), bla(TEM-1b), QnrA, QnrB, QnrS, and rmtB can be transferred to E. coli J53. Compared with those of the recipient E. coli J53, the MICs of meropenem, imipenem, levofloxacin and amikacin in the transconjugants increased by 4-128 times. CONCLUSIONS: These findings reveal that carbapenems in combination with aminoglycosides and quinolones may not be an effective option for the treatment of CRKP infections. Furthermore, the virulence and resistance genes may spread rapidly, which posing a public health risk and a significant threat to clinical care. Therefore, it is necessary to further strengthen hospital infection monitoring, prevention and control measures and to provide strict management and training on the rational use of antimicrobial agents in intensive care units.