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Characterization of hypervirulent Klebsiella pneumoniae isolates in Belgium

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Abstract

Hypervirulent Klebsiella pneumoniae (hvKp) raised concern worldwide. We studied 22 hvKp clinical invasive isolates referred to the Belgian national reference laboratory between 2014 and 2020. Sixty-four percent of the isolates expressed K2 capsular serotype and belonged to 7 different MLST lineages, while 32% expressed K1 (all belonging to ST23) and were associated with liver abscesses. Primary extra-hepatic infections were reported in 36% and sepsis for 95% of the patients with 30% of deaths. Improved clinical and microbiological diagnostics are required as hvKp may represent an underestimated cause of community-acquired invasive infections in Belgium.

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Fig. 1

Data availability

Genome assemblies were submitted to NCBI Genome and are available under BioProject ID PRJNA817214.

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References

  1. Russo TA, Marr CM (2019) Hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev 32 (3). doi:https://doi.org/10.1128/CMR.00001-19

  2. Siu LK, Yeh KM, Lin JC, Fung CP, Chang FY (2012) Klebsiella pneumoniae liver abscess: a new invasive syndrome. Lancet Infect Dis 12(11):881–887. https://doi.org/10.1016/S1473-3099(12)70205-0

    Article  PubMed  Google Scholar 

  3. Joob B, Wiwanitkit V (2017) Klebsiella pneumoniae invasive liver abscess syndrome and endophthalmitis. J Emerg Med 53(6):917. https://doi.org/10.1016/j.jemermed.2017.03.050

    Article  PubMed  Google Scholar 

  4. Fang CT, Lai SY, Yi WC, Hsueh PR, Liu KL, Chang SC (2007) Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis 45(3):284–293. https://doi.org/10.1086/519262

    Article  CAS  PubMed  Google Scholar 

  5. Melot B, Brisse S, Breurec S, Passet V, Malpote E, Lamaury I, Thiery G, Hoen B (2016) Community-acquired meningitis caused by a CG86 hypervirulent Klebsiella pneumoniae strain: first case report in the Caribbean. BMC Infect Dis 16(1):736. https://doi.org/10.1186/s12879-016-2065-2

    Article  PubMed  PubMed Central  Google Scholar 

  6. Harada S, Doi Y (2018) Hypervirulent Klebsiella pneumoniae: a call for consensus definition and international collaboration. J Clin Microbiol 56 (9). doi:https://doi.org/10.1128/JCM.00959-18

  7. Lee IR, Molton JS, Wyres KL, Gorrie C, Wong J, Hoh CH, Teo J, Kalimuddin S, Lye DC, Archuleta S, Holt KE, Gan YH (2016) Differential host susceptibility and bacterial virulence factors driving Klebsiella liver abscess in an ethnically diverse population. Sci Rep 6:29316. https://doi.org/10.1038/srep29316

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Struve C, Roe CC, Stegger M, Stahlhut SG, Hansen DS, Engelthaler DM, Andersen PS, Driebe EM, Keim P, Krogfelt KA (2015) Mapping the evolution of hypervirulent Klebsiella pneumoniae. mBio 6 (4):e00630. doi:https://doi.org/10.1128/mBio.00630-15

  9. Zhu J, Wang T, Chen L, Du H (2021) Virulence factors in Hypervirulent Klebsiella pneumoniae. Front Microbiol 12:642484. https://doi.org/10.3389/fmicb.2021.642484

    Article  PubMed  PubMed Central  Google Scholar 

  10. Peirano G, Pitout JD, Laupland KB, Meatherall B, Gregson DB (2013) Population-based surveillance for hypermucoviscosity Klebsiella pneumoniae causing community-acquired bacteremia in Calgary, Alberta. Can J Infect Dis Med Microbiol 24(3):e61-64. https://doi.org/10.1155/2013/828741

    Article  PubMed  PubMed Central  Google Scholar 

  11. Chou A, Nuila RE, Franco LM, Stager CE, Atmar RL, Zechiedrich L (2016) Prevalence of hypervirulent Klebsiella pneumoniae-associated genes rmpA and magA in two tertiary hospitals in Houston, TX, USA. J Med Microbiol 65(9):1047–1048. https://doi.org/10.1099/jmm.0.000309

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Cubero M, Grau I, Tubau F, Pallares R, Dominguez MA, Linares J, Ardanuy C (2016) Hypervirulent Klebsiella pneumoniae clones causing bacteraemia in adults in a teaching hospital in Barcelona, Spain (2007–2013). Clin Microbiol Infect 22(2):154–160. https://doi.org/10.1016/j.cmi.2015.09.025

    Article  CAS  PubMed  Google Scholar 

  13. The European Committee on Antimicrobial Susceptibility Testing. Breakpoint tables for interpretation of MICs and zone diameters. (2019).

  14. Kumabe A, Kenzaka T (2014) String test of hypervirulent Klebsiella pneumonia. QJM 107(12):1053. https://doi.org/10.1093/qjmed/hcu124

    Article  CAS  PubMed  Google Scholar 

  15. Lu J, Salzberg SL (2020) Ultrafast and accurate 16S rRNA microbial community analysis using Kraken 2. Microbiome 8(1):124. https://doi.org/10.1186/s40168-020-00900-2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Bialek-Davenet S, Criscuolo A, Ailloud F, Passet V, Jones L, Delannoy-Vieillard AS, Garin B, Le Hello S, Arlet G, Nicolas-Chanoine MH, Decre D, Brisse S (2014) Genomic definition of hypervirulent and multidrug-resistant Klebsiella pneumoniae clonal groups. Emerg Infect Dis 20(11):1812–1820. https://doi.org/10.3201/eid2011.140206

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Chen YT, Chang HY, Lai YC, Pan CC, Tsai SF, Peng HL (2004) Sequencing and analysis of the large virulence plasmid pLVPK of Klebsiella pneumoniae CG43. Gene 337:189–198. https://doi.org/10.1016/j.gene.2004.05.008

    Article  CAS  PubMed  Google Scholar 

  18. Wu KM, Li LH, Yan JJ, Tsao N, Liao TL, Tsai HC, Fung CP, Chen HJ, Liu YM, Wang JT, Fang CT, Chang SC, Shu HY, Liu TT, Chen YT, Shiau YR, Lauderdale TL, Su IJ, Kirby R, Tsai SF (2009) Genome sequencing and comparative analysis of Klebsiella pneumoniae NTUH-K2044, a strain causing liver abscess and meningitis. J Bacteriol 191(14):4492–4501. https://doi.org/10.1128/JB.00315-09

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Lery LM, Frangeul L, Tomas A, Passet V, Almeida AS, Bialek-Davenet S, Barbe V, Bengoechea JA, Sansonetti P, Brisse S, Tournebize R (2014) Comparative analysis of Klebsiella pneumoniae genomes identifies a phospholipase D family protein as a novel virulence factor. BMC Biol 12:41. https://doi.org/10.1186/1741-7007-12-41

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Guo Y, Wang S, Zhan L, Jin Y, Duan J, Hao Z, Lv J, Qi X, Chen L, Kreiswirth BN, Wang L, Yu F (2017) Microbiological and clinical characteristics of hypermucoviscous Klebsiella pneumoniae isolates associated with invasive infections in China. Front Cell Infect Microbiol 7:24. https://doi.org/10.3389/fcimb.2017.00024

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Li L, Yuan Z, Chen D, Xie X, Zhang B (2020) Clinical and microbiological characteristics of invasive and hypervirulent Klebsiella pneumoniae infections in a teaching hospital in China. Infect Drug Resist 13:4395–4403. https://doi.org/10.2147/IDR.S282982

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Lin JC, Siu LK, Fung CP, Tsou HH, Wang JJ, Chen CT, Wang SC, Chang FY (2006) Impaired phagocytosis of capsular serotypes K1 or K2 Klebsiella pneumoniae in type 2 diabetes mellitus patients with poor glycemic control. J Clin Endocrinol Metab 91(8):3084–3087. https://doi.org/10.1210/jc.2005-2749

    Article  CAS  PubMed  Google Scholar 

  23. Fazili T, Sharngoe C, Endy T, Kiska D, Javaid W, Polhemus M (2016) Klebsiella pneumoniae liver abscess: an emerging disease. Am J Med Sci 351(3):297–304. https://doi.org/10.1016/j.amjms.2015.12.018

    Article  PubMed  Google Scholar 

  24. Parrott AM, Shi J, Aaron J, Green DA, Whittier S, Wu F (2021) Detection of multiple hypervirulent Klebsiella pneumoniae strains in a New York City hospital through screening of virulence genes. Clin Microbiol Infect 27(4):583–589. https://doi.org/10.1016/j.cmi.2020.05.012

    Article  CAS  PubMed  Google Scholar 

  25. Lam MMC, Wyres KL, Judd LM, Wick RR, Jenney A, Brisse S, Holt KE (2018) Tracking key virulence loci encoding aerobactin and salmochelin siderophore synthesis in Klebsiella pneumoniae. Genome Med 10(1):77. https://doi.org/10.1186/s13073-018-0587-5

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Wyres KL, Lam MMC, Holt KE (2020) Population genomics of Klebsiella pneumoniae. Nat Rev Microbiol 18(6):344–359. https://doi.org/10.1038/s41579-019-0315-1

    Article  CAS  PubMed  Google Scholar 

  27. Catalan-Najera JC, Garza-Ramos U, Barrios-Camacho H (2017) Hypervirulence and hypermucoviscosity: two different but complementary Klebsiella spp. phenotypes? Virulence 8 (7):1111–1123. doi:https://doi.org/10.1080/21505594.2017.1317412

  28. Rodrigues C, d'Humieres C, Papin G, Passet V, Ruppe E, Brisse S (2020) Community-acquired infection caused by the uncommon hypervirulent Klebsiella pneumoniae ST66-K2 lineage. Microb Genom 6 (8). doi:https://doi.org/10.1099/mgen.0.000419

  29. Gu D, Dong N, Zheng Z, Lin D, Huang M, Wang L, Chan EW, Shu L, Yu J, Zhang R, Chen S (2018) A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study. Lancet Infect Dis 18(1):37–46. https://doi.org/10.1016/S1473-3099(17)30489-9

    Article  PubMed  Google Scholar 

  30. Emergence of hypervirulent Klebsiella pneumoniae ST23 carrying carbapenemase genes in EU/EEA countries (2021). European Centre for Disease Prevention and Control,

  31. Roulston KJ, Bharucha T, Turton JF, Hopkins KL, Mack DJF (2018) A case of NDM-carbapenemase-producing hypervirulent Klebsiella pneumoniae sequence type 23 from the UK. JMM Case Rep 5(9):e005130. https://doi.org/10.1099/jmmcr.0.005130

    Article  PubMed  PubMed Central  Google Scholar 

  32. Russo TA, Olson R, Fang CT, Stoesser N, Miller M, MacDonald U, Hutson A, Barker JH, La Hoz RM, Johnson JR (2018) Identification of biomarkers for differentiation of hypervirulent Klebsiella pneumoniae from classical K. pneumoniae. J Clin Microbiol 56 (9). doi:https://doi.org/10.1128/JCM.00776-18

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Funding

The Belgian national reference center for antibiotic-resistant Gram-negative bacilli is supported in part by the Belgian Ministry of Social Affairs through a fund within the National health insurance system (INAMI-RIZIV).

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Author notes

  1. Ahalieyah Anantharajah

    Present address: Department of Clinical Microbiology, Cliniques Universitaires Saint-Luc, UCL, Brussels, Belgium

Authors and Affiliations

  1. Department of Clinical Microbiology, National Reference Center for Antibiotic-Resistant Gram-Negative Bacilli, CHU UCL Namur, Yvoir, Belgium

    Ahalieyah Anantharajah, Matthieu Deltombe, Marie de Barsy, Stephanie Evrard, Olivier Denis, Pierre Bogaerts, Youri Glupczynski & Te-Din Huang

  2. Department of Microbiology, Laboratoire Hospitalier Universitaire de Bruxelles (LHUB-ULB), Brussels, Belgium

    Marie Hallin & Véronique Yvette Miendje Deyi

  3. Department of Microbiology, Universiteit Ziekenhuis Brussel, Brussels, Belgium

    Denis Pierard

  4. Department of Microbiology, Ziekenhuis Netwerk Antwerpen, Antwerp, Belgium

    Peggy Bruynseels

  5. Department of Microbiology, Ghent University Hospital, Ghent, Belgium

    Jerina Boelens

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  1. Ahalieyah Anantharajah
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Corresponding author

Correspondence to Ahalieyah Anantharajah.

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All procedures were performed in accordance with the ethical standards of the national research committee and in accordance with the 1964 Helsinki Declaration. Information from microbiological and clinical files was anonymously analyzed and did not require patient’s informed consent.

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Anantharajah, A., Deltombe, M., de Barsy, M. et al. Characterization of hypervirulent Klebsiella pneumoniae isolates in Belgium. Eur J Clin Microbiol Infect Dis 41, 859–865 (2022). https://doi.org/10.1007/s10096-022-04438-z

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