Molecular epidemiology of carbapenem-resistant hypervirulent Klebsiella pneumoniae in China

Figures & data

Table 1. Prevalence of CRKP and virulence plasmid-bearing CRKP (including both non-phenotypic CR-HvKP and phenotypic CR-HvKP) strains in three different hospitals in China; the proportion of ST11 type among these strains is also shown.

Hospital	Year	Number of strains (%)
		CRKP	Virulence plasmid-bearing CRKP	phenotypic CR-HvKP	Total	ST11
HPPH	2014	16 (53)	14 (47)	3 (10)	30	21 (70)
	2015	12 (44)	15 (56)	2 (7)	27	23 (85)
	2016	33 (34)	65 (66)	3 (3)	98	91 (93)
	2017	17 (43)	12 (57)	3 (4)	29	27 (93)
	Total	78 (42)	106 (58)	11 (6)	184	162 (88)
SAHZU	2014	34 (90)	4 (11)	0	38	33 (87)
	2015	69 (76)	21 (23)	0	90	76 (84)
	2016	12 (12)	87 (88)	6 (6)	99	91(92)
	2017	29 (29)	70 (71)	18 (18)	99	70 (71)
	Total	150 (46)	176 (54)	24 (7)	326	272 (83)
WZTH	2014	21 (28)	53 (72)	7 (10)	74	71 (96)
	2015	25 (30)	58 (70)	9 (11)	83	63 (76)
	2016	10 (31)	22 (69)	2 (6)	32	31 (97)
	2017	49 (58)	36 (42)	7 (8)	85	77 (91)
	Total	105 (38)	169 (62)	25 (9)	274	242 (88)
All three hospitals	2014	71 (50)	71 (50)	10 (7)	142	125 (88)
	2015	106 (53)	94 (47)	11 (6)	200	162 (81)
	2016	55 (24)	174 (76)	11 (5)	229	213 (93)
	2017	95 (45)	118 (55)	28 (13)	213	174 (82)
	Total	327 (42)	457 (58)	60 (8)	784	674 (86)

Table 2. Antimicrobial susceptibility of clinical CRKP and CR-HvKP strains.

Antibiotics	Range	CRKP (n = 784)				CR-HvKP (n = 60)
		MIC50	MIC90	%S	%R	MIC50	MIC90	%S	%R
Ceftazidime	≤4–>128	64	>128	1	99	32	>128	0	100
Cefotaxime	≤4–>128	>128	>128	0	100	>128	>128	0	100
Amikacin	≤4–>128	>128	>128	27	73	>128	>128	18	82
Ciprofloxacin	≤1–>32	>32	>32	2	98	32	>32	0	100
Cefmetazole	≤2–>128	128	>128	2	98	128	>128	0	100
Cefepime	≤4–>64	>64	>64	1	99	>64	>64	0	100
Piperacillin- tazobactam	128/4–>256/4	>256/4	>256/4	0	100	>256/4	>256/4	0	100
Colistin	≤0.5–>8	≤0.5	2	96	4	≤0.5	1	94	6
Imipenem	≤0.5–>128	32	64	1	100	32	64	0	100
Meropenem	2–>128	128	>128	0	100	128	>128	0	100
Ertapenem	8–>128	>128	>128	0	100	128	>128	0	100
Cefoperazone- sulbactam	32/16–>128/64	>128/64	>128/64	0	100	>128/64	>128/64	0	100
Tigecycline^a	≤0.25–4	1	2	79	21	1	2	69	31
Aztreonam	32–>128	>128	>128	0	100	>128	>128	0	100

^a For tigecycline, NS (non-susceptible) % was used here to replace R% (resistance). The proportion of CRKP and CR-HvKP strains that exhibited intermediate resistance was 19% and 31%, respectively.

Figure 1. ST distribution among CRKP, non-phenotypic and phenotypic CR-HvKP strains. ST11 (n = 676), ST15 (n = 20), ST290 (n = 16), ST2193 (n = 8), ST86 (n = 6), ST1 (n = 5), ST437 (n = 5), ST268 (n = 4), ST595 (n = 3), ST395 (n = 2), ST48, ST76, ST859, ST1030, ST1912 (n = 1). SAHZU, Second Affiliated Hospital of Zhejiang University; HPPH, Henan Province People’s Hospital; WZTH, Wenzhou Tertiary Hospital.

Figure 2. Genetic characteristics of CRKP strains. KL, serotypes; ST, ST types; Locations: ZJ (SAHZU), Second Affiliated Hospital of Zhejiang University; HN (HPPH), Henan Province People’s Hospital; WZ (WZTH), Wenzhou Tertiary Hospital. The bla_KPC-2-bearing plasmid: IncFII – carriage of IncFII replicon; non-IncFII – without carriage of IncFII replicon.

Data availability statement

Assembled genome sequences of the strains used in this study have been deposited in the GenBank database under BioProject number PRJNA503173.