Gorrie, Claire L; Mirčeta, Mirjana; Wick, Ryan R; Judd, Louise M; Lam, Margaret MC; Gomi, Ryota; Abbott, Iain J; Thomson, Nicholas R; Strugnell, Richard A; Pratt, Nigel F; +9 more... Garlick, Jill S; Watson, Kerrie M; Hunter, Peter C; Pilcher, David V; McGloughlin, Steve A; Spelman, Denis W; Wyres, Kelly L; Jenney, Adam WJ; Holt, Kathryn E; (2022) Genomic dissection of Klebsiella pneumoniae infections in hospital patients reveals insights into an opportunistic pathogen. Nature communications, 13 (1). 3017-. ISSN 2041-1723 DOI: https://doi.org/10.1038/s41467-022-30717-6
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Abstract
Klebsiella pneumoniae is a major cause of opportunistic healthcare-associated infections, which are increasingly complicated by the presence of extended-spectrum beta-lactamases (ESBLs) and carbapenem resistance. We conducted a year-long prospective surveillance study of K. pneumoniae clinical isolates in hospital patients. Whole-genome sequence (WGS) data reveals a diverse pathogen population, including other species within the K. pneumoniae species complex (18%). Several infections were caused by K. variicola/K. pneumoniae hybrids, one of which shows evidence of nosocomial transmission. A wide range of antimicrobial resistance (AMR) phenotypes are observed, and diverse genetic mechanisms identified (mainly plasmid-borne genes). ESBLs are correlated with presence of other acquired AMR genes (median n = 10). Bacterial genomic features associated with nosocomial onset are ESBLs (OR 2.34, p = 0.015) and rhamnose-positive capsules (OR 3.12, p < 0.001). Virulence plasmid-encoded features (aerobactin, hypermucoidy) are observed at low-prevalence (<3%), mostly in community-onset cases. WGS-confirmed nosocomial transmission is implicated in just 10% of cases, but strongly associated with ESBLs (OR 21, p < 1 × 10-11). We estimate 28% risk of onward nosocomial transmission for ESBL-positive strains vs 1.7% for ESBL-negative strains. These data indicate that K. pneumoniae infections in hospitalised patients are due largely to opportunistic infections with diverse strains, with an additional burden from nosocomially-transmitted AMR strains and community-acquired hypervirulent strains.
Item Type | Article |
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Faculty and Department | Faculty of Infectious and Tropical Diseases > Department of Infection Biology |
Research Centre | Antimicrobial Resistance Centre (AMR) |
PubMed ID | 35641522 |
Elements ID | 180261 |