Carbapenem-resistant hypervirulent Klebsiella pneumoniae

From WikiProjectMed
Jump to navigation Jump to search
Carbapenem-resistant hypervirulent Klebsiella pneumoniae
Other names: CR-hvKP[1]
Carbapenem resistance mechanisms and virulence factors of carbapenem-resistant hypervirulent K. pneumoniae.[2]
SpecialtyInfectious disease
SymptomsFever,chills,abdominal pain,nausea [3]
ComplicationsPyogenic liver abscess, endophthalmitis, meningitis[4]
Diagnostic methodPCR[5]
Differential diagnosisClassic Klebsiella pneumoniae, other K. pneumoniae strains[5]
PreventionInfection control[6]
MedicationCeftazidime/Avibactam(has shown some effectiveness)[1]
FrequencyIdentified worldwide [6]

Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) is a strain of Klebsiella pneumoniae. This bacterium combines two traits: hypervirulence and resistance to carbapenem antibiotics. Carbapenems are many times used as a last resort for treating infections of a bacterial nature.[6]

Ceftazidime/avibactam has some effectiveness against CR-hvKP.[1] In China sequence type 11 (ST11) dominates the majority of CRhvKP strains.[4]

Signs and symptoms

In terms of the presentation of Carbapenem-resistant hypervirulent Klebsiella pneumoniae we find:[3]

Complications

As to the complications possibly exhibited by an infected individual we find:[4]

  • Meningitis

    Meningitis

  • Hepatica abscess due to infection

    Hepatica abscess due to infection

Mechanism

As to the mechanism, carbapenem antibiotic treatment becomes ineffective because CR-hvKP strains produce enzymes such as New Delhi metallo-beta-lactamase that break down carbapenem antibiotics.[7][2]Overexpression of efflux pumps helps the bacteria expel antibiotic, thereby reducing their effectiveness[2]

CR-hvKP can get resistance genes via plasmids, which are mobile genetic elements that can transfer between bacteria.[8]In a recent 2024 article we find that Carbapenem-resistant hypervirulent ST23 Klebsiella pneumoniae with a highly transmissible dual-carbapenemase plasmid in Chile was detected(image below-left)[9][2].

  • Representation of the main resistance genes, virulence factors, and mobile genetic elements in the CR-hvKp strain K. pneumoniae VA585-22[9][1]

    Representation of the main resistance genes, virulence factors, and mobile genetic elements in the CR-hvKp strain K. pneumoniae VA585-22[9][1]

  • Map of hypervirulence and carbapenem resistance hybrid plasmids(regions of homology with closely related carbapenem resistance plasmids/virulence plasmids)[10]

    Map of hypervirulence and carbapenem resistance hybrid plasmids(regions of homology with closely related carbapenem resistance plasmids/virulence plasmids)[10]

Diagnosis

PCR tubes

Diagnosis involves the following:[11][5]

  • Symptoms
  • PCR (lab identification)

Differential diagnosis

Other conditions that may appear similar include the following:[5]

  • Classic Klebsiella pneumoniae
  • Other K. pneumoniae strains

Prevention

In terms of preventive measures for Carbapenem-resistant hypervirulent Klebsiella pneumoniae the WHO indicates that, "enhanced IPC measures should be in place for the prompt management of suspected and/or confirmed cases." [6]

Treatment

In terms of management we find that while a review article by Lei, et al indicates "currently, there are no effective methods for treating and surveillance [of] this pathogen": we also find that a 2022 article per Tang, et al indicates ceftazidime/avibactam combination has shown some effectiveness against CR-hvKP in a hospitalized individual.[12][1]

Epidemiology

The World Health Organization for its part has indicated that, "countries should strengthen clinical and public health awareness for the detection of carbapenem resistance (CR)-hvKp".[6]

(CR)-hvKp has been identified in all six WHO regions; Africa, Americas, Eastern Mediterranean, South-East Asia, European and Western Pacific region.[6]

Strain ST23-K1 was detected and reported to WHO by Algeria, Argentina, Australia, Canada, India, Iran, Japan, Oman, Philippines, Switzerland, Thailand and United Kingdom[6] A separate report indicates Chile as well[13]

In terms of prevalence in healthcare settings we find that CR-hvKP is becoming a dominant nosocomial pathogen. Studies have indicated that certain sequence types( ST11) are highly prevalent among CR-hvKP isolates[14]


  • World distribution of virulence genes of carbapenem-resistant hypervirulent Klebsiella pneumoniae[2]

    World distribution of virulence genes of carbapenem-resistant hypervirulent Klebsiella pneumoniae[2]

  • Distribution of hypervirulent and carbapenem-resistant Klebsiella pneumoniae (CR-hvKP) [10]

    Distribution of hypervirulent and carbapenem-resistant Klebsiella pneumoniae (CR-hvKP) [10]

History

Carl Friedlander first described Klebsiella pneumoniae from the lungs of people who had died from pneumonia in 1882. The bacterium was originally called Friedlander's bacillus, but was later renamed Klebsiella. [15]

The first carbapenem-resistant Klebsiella pneumoniae strains were identified in 1996. This development of CRKP strains is due to the frequent use of antimicrobials.[16]

Research

In terms of research into CR-hvKP Dr. Russo at University of Buffalo has identified several genetic elements responsible for turning classical Klebsiella pneumoniae into hypervirulent strains. [17]

Notes

1.^ Due to few,PubMed indexed, reviews on Carbapenem-resistant hypervirulent Klebsiella pneumoniae, which first came to light in 2016, some primary articles have been included

References

  1. ↑ 1.0 1.1 1.2 1.3 Tang, Na; Hu, Jinshu; Zhao, Yingying; Song, Yuqin; Wang, Chao; Zhang, Gang; Wei, Dawei; Fang, Hailing; Li, Chao; Jia, Rufu; Feng, Jie (2 February 2022). "In vivo evolution of carbapenem resistance in hypervirulent Klebsiella pneumoniae in a patient undergoing long-term treatment". Journal of Antimicrobial Chemotherapy. 77 (2): 531–533. doi:10.1093/jac/dkab380. Archived from the original on 20 September 2024. Retrieved 18 September 2024.
  2. ↑ 2.0 2.1 2.2 2.3 Mendes, Gabriel; Santos, Maria Leonor; Ramalho, João F.; Duarte, Aida; Caneiras, Cátia (2023). "Virulence factors in carbapenem-resistant hypervirulent Klebsiella pneumoniae". Frontiers in Microbiology. 14: 1325077. doi:10.3389/fmicb.2023.1325077. ISSN 1664-302X. Archived from the original on 2024-09-18. Retrieved 2024-09-18.
  3. ↑ 3.0 3.1 "Public Health Rapid Risk Assessment related to hypervirulent Klebsiella pneumoniae carrying carbapenemase genes in the Region of the Americas". PAHO. Archived from the original on 10 July 2024. Retrieved 26 September 2024.
  4. ↑ 4.0 4.1 4.2 Chen, Tao; Ying, Liya; Xiong, Luying; Wang, Xueting; Lu, Ping; Wang, Yuan; Shen, Ping; Xiao, Yonghong (26 June 2024). "Understanding carbapenem-resistant hypervirulent Klebsiella pneumoniae: Key virulence factors and evolutionary convergence". hLife. doi:10.1016/j.hlife.2024.06.005. ISSN 2949-9283.
  5. ↑ 5.0 5.1 5.2 5.3 Liao, Wenjian; Long, Dan; Huang, Qisen; Wei, Dandan; Liu, Xiaobing; Wan, Lagen; Feng, Yuling; Zhang, Wei; Liu, Yang (4 June 2020). "Rapid Detection to Differentiate Hypervirulent Klebsiella pneumoniae (hvKp) From Classical K. pneumoniae by Identifying peg-344 With Loop-Mediated Isothermal Amplication (LAMP)". Frontiers in Microbiology. 11. doi:10.3389/fmicb.2020.01189. ISSN 1664-302X. Archived from the original on 26 September 2024. Retrieved 20 September 2024.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 "Antimicrobial Resistance, Hypervirulent Klebsiella pneumoniae - Global situation". www.who.int. Archived from the original on 2024-09-08. Retrieved 2024-09-18.
  7. ↑ Wang, Qian; Liu, Yue; Chen, Ran; Zhang, Meng; Si, Zaifeng; Wang, Yueling; Jin, Yan; Bai, Yuanyuan; Song, Zhen; Lu, Xinglun; Hao, Mingju; Hao, Yingying (29 March 2024). "Genomic insights into the evolution and mechanisms of carbapenem-resistant hypervirulent Klebsiella pneumoniae co-harboring blaKPC and blaNDM: implications for public health threat mitigation". Annals of Clinical Microbiology and Antimicrobials. 23 (1): 27. doi:10.1186/s12941-024-00686-3. ISSN 1476-0711. Archived from the original on 28 May 2024. Retrieved 21 September 2024.
  8. ↑ Han, Yu-Ling; Wen, Xu-Hui; Zhao, Wen; Cao, Xi-Shan; Wen, Jian-Xun; Wang, Jun-Rui; Hu, Zhi-De; Zheng, Wen-Qi (12 September 2022). "Epidemiological characteristics and molecular evolution mechanisms of carbapenem-resistant hypervirulent Klebsiella pneumoniae". Frontiers in Microbiology. 13. doi:10.3389/fmicb.2022.1003783. ISSN 1664-302X. Archived from the original on 25 September 2024. Retrieved 21 September 2024.
  9. ↑ 9.0 9.1 >Gálvez-Silva, Matías; Arros, Patricio; Berríos-Pastén, Camilo; Villamil, Aura; Rodas, Paula I.; Araya, Ingrid; Iglesias, Rodrigo; Araya, Pamela; Hormazábal, Juan C.; Bohle, Constanza; Chen, Yahua; Gan, Yunn-Hwen; Chávez, Francisco P.; Lagos, Rosalba; Marcoleta, Andrés E. (12 March 2024). "Carbapenem-resistant hypervirulent ST23 Klebsiella pneumoniae with a highly transmissible dual-carbapenemase plasmid in Chile". Biological Research. 57 (1): 7. doi:10.1186/s40659-024-00485-2. ISSN 0717-6287. Archived from the original on 23 September 2024. Retrieved 20 September 2024.
  10. ↑ 10.0 10.1 Lan, Peng; Jiang, Yan; Zhou, Jiancang; Yu, Yunsong (1 June 2021). "A global perspective on the convergence of hypervirulence and carbapenem resistance in Klebsiella pneumoniae". Journal of Global Antimicrobial Resistance. 25: 26–34. doi:10.1016/j.jgar.2021.02.020. ISSN 2213-7165. Archived from the original on 31 October 2023. Retrieved 17 September 2024.
  11. ↑ Mai, Dongmei; Wu, Anqi; Li, Ran; Cai, Donghao; Tong, Huichun; Wang, Nan; Tan, Junqing (29 November 2023). "Identification of hypervirulent Klebsiella pneumoniae based on biomarkers and Galleria mellonella infection model". BMC Microbiology. 23 (1): 369. doi:10.1186/s12866-023-03124-0. ISSN 1471-2180. Archived from the original on 25 September 2024. Retrieved 20 September 2024.
  12. ↑ Lei, Ting-yu; Liao, Bin-bin; Yang, Liang-Rui; Wang, Ying; Chen, Xu-bing (1 November 2024). "Hypervirulent and carbapenem-resistant Klebsiella pneumoniae: A global public health threat". Microbiological Research. 288: 127839. doi:10.1016/j.micres.2024.127839. ISSN 0944-5013.
  13. ↑ Gálvez-Silva, Matías; Arros, Patricio; Berríos-Pastén, Camilo; Villamil, Aura; Rodas, Paula I.; Araya, Ingrid; Iglesias, Rodrigo; Araya, Pamela; Hormazábal, Juan C.; Bohle, Constanza; Chen, Yahua; Gan, Yunn-Hwen; Chávez, Francisco P.; Lagos, Rosalba; Marcoleta, Andrés E. (12 March 2024). "Carbapenem-resistant hypervirulent ST23 Klebsiella pneumoniae with a highly transmissible dual-carbapenemase plasmid in Chile". Biological Research. 57 (1): 7. doi:10.1186/s40659-024-00485-2. ISSN 0717-6287. Archived from the original on 23 September 2024. Retrieved 20 September 2024.
  14. ↑ Li, Linlin; Li, Shan; Wei, Xianzhen; Lu, Zhaolu; Qin, Xue; Li, Meng (13 November 2023). "Infection with Carbapenem-resistant Hypervirulent Klebsiella Pneumoniae: clinical, virulence and molecular epidemiological characteristics". Antimicrobial Resistance & Infection Control. 12 (1): 124. doi:10.1186/s13756-023-01331-y. ISSN 2047-2994. Archived from the original on 27 August 2024. Retrieved 22 September 2024.
  15. ↑ Ashurst, John V.; Dawson, Adam (2024). "Klebsiella Pneumonia". StatPearls. StatPearls Publishing. Archived from the original on 2020-05-15. Retrieved 2024-09-23.
  16. ↑ Karampatakis, Theodoros; Tsergouli, Katerina; Behzadi, Payam (21 January 2023). "Carbapenem-Resistant Klebsiella pneumoniae: Virulence Factors, Molecular Epidemiology and Latest Updates in Treatment Options". Antibiotics. 12 (2): 234. doi:10.3390/antibiotics12020234. ISSN 2079-6382.
  17. ↑ Russo, Thomas A.; Carlino-MacDonald, Ulrike; Drayer, Zachary J.; Davies, Connor J.; Alvarado, Cassandra L.; Hutson, Alan; Luo, Ting L.; Martin, Melissa J.; McGann, Patrick T.; Lebreton, Francois (September 2024). "Deciphering the relative importance of genetic elements in hypervirulent Klebsiella pneumoniae to guide countermeasure development". eBioMedicine. 107: 105302. doi:10.1016/j.ebiom.2024.105302. Archived from the original on 2024-09-20. Retrieved 2024-09-24.

Further reading

Retrieved from "https://mdwiki.org/w/index.php?title=Carbapenem-resistant_hypervirulent_Klebsiella_pneumoniae&oldid=1438272"