Abstract:
OBJECTIVE To investigate the molecular epidemiological characteristics and clonal transmission of carbapenem-resistant
Klebsiella pneumoniae (CRKP) in the intensive care units (ICUs).
METHODS A total of 60 non-repetitive CRKP strains isolated from hospitalized patients in the ICUs and respiratory ICUs of Fujian University of Traditional Chinese Medicine Affiliated People's Hospital from Jan. 2022 to Jul. 2025 were collected. Whole-genome sequencing was performed with next-generation sequencing technology, and bioinformatics methods were employed to analyze their homology, antimicrobial resistance genes and virulence genes. Transmission chain tracing was conducted by integrating patients' clinical information and epidemiological data.
RESULTS Among the 60 CRKP strains, 11 (18.33%) carried the
blaKPC-2 carbapenemase gene and simultaneously harbored rmpA2 and a complete aerobactin iron carrier system. Among these strains, 6 (54.55%) formed a highly homologous ST11-KL25 hypervirulent carbapenem-resistant
Klebsiella pneumoniae (HCKP) clone cluster (core genome SNP differences ≤7). Epidemiological investigation revealed geographical and temporal overlaps among these 6 cases. Core genome phylogenetic analysis indicated that this outbreak clone was genetically distant from other CRKP strains in the study, suggesting recent introduction or independent evolution.
CONCLUSIONS This study is the first to report a hospital-associated outbreak caused by ST11-KL25 HCKP clones co-harboring
blaKPC-2 resistance genes and hypervirulence genes. The emergence of this "resistance-virulence" convergent clone poses a serious threat to clinical practice, highlighting the urgent need for strengthened surveillance and infection control measures against CRKP in hospitals.