Phenotypic and Genomic Characterization of Virulence Heterogeneity in Multidrug-Resistant ST11 Klebsiella pneumoniae During Inter-Host Transmission and Evolution

Figures & data

Table 1 Clinical Characteristics of Patients with Klebsiella pneumonia Infection

Patient	Age	Sex	Specimen	Collection Date	Department	Immunosuppression	Antibiotic Agent Exposure	Intubation	HAI	Type of Infection	APACHE II >16	SOFA ≥6	CCI	Outcome in 30 Days
Z1	78	M	Sputum	20171218	Respiratory-N	N	Y	Y	Y	VAP	Y	Y	6	Survive
Z3	60	M	Sputum	20180101	Respiratory-H	Y	Y	Y	Y	Pneumonia	Y	Y	3	Survive
Z4	48	M	Tissue	20180103	Respiratory-H	Y	Y	Y	Y	Pneumonia	Y	Y	4	Survive
Z5	73	F	Urine	20180104	Gastroenterology-H	N	Y	Y	Y	UTI	Y	N	3	Death**
Z6	37	M	BALF	20180104	Respiratory-H	N	Y	Y	Y	VAP	N	Y	1	Survive
Z7	87	M	Sputum	20180108	SICU	Y	Y	Y	Y	VAP	Y	Y	4	Survive
Z9	57	F	Tissue	20180112	Respiratory-H	Y	Y	N	Y	Pneumonia	N	N	3	Survive
Z10	35	M	Sputum	20180115	Internal Medicine	N	Y	Y	Y	VAP	N	N	3	Survive
Z12	80	M	Sputum	20180121	Respiratory-N	Y	Y	Y	Y	Pneumonia	Y	Y	6	Survive
Z13	82	F	Sputum	20180122	Respiratory-N	N	Y	Y	Y	Pneumonia	N	Y	3	Survive
Z14	44	F	BALF	20180122	Respiratory-H	Y	Y	Y	Y	VAP	N	Y	1	Death
Z15	87	F	Urine	20180201	Respiratory-N	N	Y	N	Y	CAUTI	Y	Y	4	Survive
Z17	42	F	Drainage liquid	20180208	SICU	Y	Y	Y	Y	Pneumonia	N	Y	4	Death
Z18	35	M	BALF	20180211	Respiratory-H	Y	Y	Y	Y	VAP	Y	Y	4	Death
Z19	80	M	Sputum	20180213	SICU	Y	Y	Y	Y	VAP	Y	Y	14	Death
Z20	28	M	Sputum	20180224	Respiratory-H	Y	Y	Y	Y	VAP	N	N	1	Death**
Z21	84	F	Sputum	20180218	Respiratory-H	N	Y	N	CAI	Pneumonia	N	N	1	Survive
Z22	87	F	Urine	20180221	Respiratory-N	N	Y	Y	Y	CAUTI	Y	Y	4	Death
Z23	81	M	Urine	20180222	Nephrology-N	Y	Y	Y	Y	CAUTI	Y	Y	4	Death
Z24	86	F	Urine	20180224	General Medicine-N	N	Y	Y	Y	UTI	Y	N	5	Survive
Z25	83	F	Sputum	20180309	SICU	Y	Y	Y	Y	Pneumonia	Y	Y	5	Survive
Z26	70	F	Sputum	20180310	Respiratory-N	Y	Y	Y	Y	VAP	Y	Y	5	Death
Z27	68	M	Sputum	20180315	SICU	N	Y	Y	Y	VAP	Y	Y	2	Death
Z28	35	M	Sputum	20180317	Neurology-N	Y	Y	Y	Y	Pneumonia	Y	N	2	Survive
Z29	76	M	BALF	20180417	Respiratory-H	Y	Y	Y	Y	VAP	Y	N	6	Survive
Z31	58	F	BALF	20180427	Respiratory-N	N	Y	Y	Y	Pneumonia	N	N	2	Death
Z32	28	F	Blood	20170618	Respiratory-N	Y	Y	Y	Y	BSI	Y	Y	4	Death
Z33	58	M	Sputum	20180517	Respiratory-H	Y	Y	Y	Y	VAP	Y	N	3	Survive
Z35	78	F	BALF	20180529	Respiratory-H	N	Y	Y	Y	VAP	Y	Y	2	Death
Z36	78	M	Sputum	20180614	Respiratory-N	N	Y	Y	Y	Pneumonia	Y	Y	4	Death**
Z37	78	F	BALF	20180617	Respiratory-H	N	Y	Y	CAI	VAP	N	Y	6	Death
Z38	57	F	Urine	20180618	CCU	N	Y	Y	Y	CAUTI	Y	Y	5	Survive
Z39	90	F	Sputum	20180110	Respiratory-N	N	Y	Y	Y	Pneumonia	N	Y	4	Survive

Note: **Withheld life-sustainable treatment; The -H and -N department means headquarters and north campus, respectively.

Abbreviations: CAI, community-acquired infection; HAI, hospital-acquired infection; BALF, bronchoalveolar lavage fluid; CAUTI, catheter-associated urinary tract infection; VAP, ventilator-associated pneumonia; BSI, bloodstream infection; UTI, urinary tract infection; SICU, surgery intensive care medicine; CCU, cardiac intensive care unit. Y, yes; N, no.

Figure 1 Phylogenetic tree of MDR-Kp strains. Brown: positive. Green: hospital-acquired infection. Purple: community-acquired infection. Blue: KL47. Pink: KL64. Hypervirulent phenotype: G mellonella mortality is not lower than the reference strain (K1-hvKp) at 48 h.

Figure 2 Evolutionary and transmission map of isolated Kp strains. Brown: clade 1 strains. Green: clade 2a strains. Blue: clade 2b strains. Black circle, ancestral strain determined by SNP analysis. Gray, strains during transmission not captured in this study. Red numbers, hvKp defined by the combination of five key virulence genes. The numbers on the arrows are SNPs.