Emergence of Carbapenem-Resistant Hypervirulent ST111 K63 Klebsiella pneumoniae in China

Ying Zhu; Xinmiao Jia; Peiyao Jia; Xiaoyu Liu; Xue Li; Wei Yu; Qing Yang; Huabing Yin; Qiaoxin Hao; Qiwen Yang

doi:10.33073/pjm-2026-011

Figures & Tables

The survival curve of six-week CD1 mice after the intraperitoneal infection with the clinical strain, AZJ065 and the controls, NTUH-K2044 (K2044) and QD110. Each strain was tested by 1×107 CFU in 100μl PBS with five mice. P value from the log-rank (Mantel-Cox) test was 0.0442 (<0.05) between AZJ065 and K2044, indicating the virulence of AZJ065 was significantly different from that of K2044 and was even higher than that of K2044.

Circular representation of AZJ065 genome (chromosome and two plasmids). Circles are shown as follows (outside to inside): (1) A physical map scaled in megabases (Mb) from base 1 (the start of the putative replication origin); (2) coding sequences transcribed in a clockwise direction; (3) coding sequences transcribed in a counter-clockwise direction; (4) G + C content; (5) GC skew; (6) tRNA genes; (7) rRNA genes. Genes displayed in (2) and (3) are color-coded according to different functional categories shown on the right.

Genomic structure comparison of pAZJ065-Hv and pM186-2. (A) Alignments of resemble plasmids are shown as concentric rings. The outermost shows the main coding genes of pAZJ065-Hv. Virulence genes are highlighted in red. (B) Linear structure comparison of region harboring virulence genes on plasmids pAZJ065-Hv and pM186-2. Genes, mobile elements, and other features are colored based on functional classification. Shading denotes the regions with high homology (>95% nucleotide identity).

Genomic structure comparison of pAZJ065-KPC and three most similar plasmids (Klebsiella pneumoniae p24169-KPC, Escherichia coli pBK32602, Raoultella planticola pFDAARGOS_430). (A) Alignments of similar plasmids are shown as concentric rings. The outermost shows the main coding genes of pAZJ065-KPC. Resistance genes are highlighted in red. (B) The upper figure presents the related transposons and integrons comparison of plasmids pAZJ065-KPC and the three most similar plasmids in linear structure pattern. The lower one presents regions harboring resistance genes on plasmids. Genes, mobile elements, and other features are colored based on functional classification. Shading denotes the regions with high homology (>95% nucleotide identity).

(A) Gene homology cluster of four ST111 K63 clinical strains. ‘1’ represents the presence of the genes in the strain and “0” represents the absence of the genes in the strain. (B) The phylogenetic tree of four ST111 K63 clinical strains based on core gene SNPs from whole-genome sequence.

The clinical information and antimicrobial susceptibility of the clinical strains, AZJ065 and three ST111 K63 strains

Strain		AZJ065	SCQ159	SYF150	SZS111
Province		Zhejiang	Chongqing	Zhejiang	Shanghai
Hospital		The First Affiliated Hospital of Zhejiang University	The First Affiliated Hospital of Zhejiang University	Sir Run Run Shaw Hospital	Zhongshan Hospital of Fu Dan University
Gender		Male	Male	Male	Female
Age (year)		79	66	82	69
Department		ICU	Medical ward	ICU	Surgery
Primary Infection Site		Urinary tract infection	Liver abscess	Intra-abdominal infection	Intra-abdominal infection
Duration of fever (Day)		6-14	>14	6-14	3-15
Peak of fever (°C)		>39	>39	38-39	>39
Laboratory data*	WBC (1×10⁹/I)	10.1	35.25	17.5	6.78
	N%	92.8	94.4	94.8	58.9
	CRP (mg/l)	101	>90	256.2	11.5
	PCT (ng/ml)	0.77	>200	5.43	2.53
ICU Admission		Yes	No	Yes	No
Antibiotic use 2g q12h		Fluconazole, Cefoperazone sulbactam	Imipenem/cilastatin 1g q8h	Meropenem 0.5g q6hVancomycin 1g q12h	Meropenem 1g q12h
Antibiotic use 2g q12h		Cefoxitin 2g q8h		Meropenem 0.5g q6hVancomycin 1g q12h
Discharge status		Treatment failure	Improved	Died	Improved
MIC (μg/ml)	Colistin (S≤2 mg/L)	≤1	≤1	≤1	≤1
	Levofloxacin (S≤0.5 mg/L)	1	≤0.5	≤0.5	≤0.5
	Amikacin (S≤16 mg/L)	≤4	≤4	≤4	≤4
	Ceftazidime-avibactam (S≤8 mg/L)	0.5	≤0.12	0.25	≤0.12
	Ciprofloxacin (S≤0.25 mg/L)	1	≤0.25	≤0.25	≤0.25
	Aztreonam (S≤ 4 mg/L)	>128	≤1	≤1	≤1
	Ceftazidime (S≤ 4 mg/L)	32	≤1	≤1	≤1
	Cefoxitin (S≤ 8 mg/L)	>16	≤2	8	≤2
	Ceftriaxone (S≤ 1 mg/L)	>8	≤1	≤1	≤1
	Ertapenem (S≤0.5 mg/L)	>4	≤0.06	≤0.06	≤0.06
	Meropenem (S≤ 1 mg/L)	>16	≤0.12	≤0.12	≤0.12
	Imipenem (S≤ 1 mg/L)	>16	≤0.12	≤0.12	≤0.12
	Cefepime (S≤ 2 mg/L)	>32	≤1	≤1	≤1
	Imipenem-relebactam (S≤ 1 mg/L)	1	0.25	0.25	≤0.12
	Ceftolozone-tazobactam (S≤ 2/4 mg/L)	>16	≤0.12	0.5	0.25
	Piperacillin-tazobactam (S≤ 8 mg/L)	>64	≤2	8	≤2

Emergence of Carbapenem-Resistant Hypervirulent ST111 K63 Klebsiella pneumoniae in China

Figures & Tables

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The clinical information and antimicrobial susceptibility of the clinical strains, AZJ065 and three ST111 K63 strains

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