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Januar 2021

A Klebsiella pneumoniae ST307 outbreak clone from Germany demonstrates features of extensive drug resistance, hypermucoviscosity, and enhanced iron acquisition”

Stefan E. Heiden*, Nils-Olaf Hübner*, Jürgen A. Bohnert, Claus-Dieter Heidecke, Axel Kramer, Veronika Balau, Wolfgang Gierer, Stephan Schaefer, Tim Eckmanns, Sören Gatermann, Elias Eger, Sebastian Guenther, Karsten Becker & Katharina Schaufler#

Genome Medicine, 2020, 12:113
Link zum vollständigen Artikel: pubmed.ncbi.nlm.nih.gov/33298160/


Stefan Heiden         Nils Hübner

Original Abstract des Artikels
Background
Antibiotic-resistant Klebsiella pneumoniae are a major cause of hospital- and community-acquired infections, including sepsis, liver abscess, and pneumonia, driven mainly by the emergence of successful high-risk clonal lineages. The K. pneumoniae sequence type (ST) 307 lineage has appeared in several different parts of the world after first being described in Europe in 2008. From June to October 2019, we recorded an outbreak of an extensively drug-resistant ST307 lineage in four medical facilities in north-eastern Germany.
Methods
Here, we investigated these isolates and those from subsequent cases in the same facilities. We performed whole-genome sequencing to study phylogenetics, microevolution, and plasmid transmission, as well as phenotypic experiments including growth curves, hypermucoviscosity, siderophore secretion, biofilm formation, desiccation resilience, serum survival, and heavy metal resistance for an in-depth characterization of this outbreak clone.
Results
Phylogenetics suggest a homogenous phylogram with several sub-clades containing either isolates from only one patient or isolates originating from different patients, suggesting inter-patient transmission. We identified three large resistance plasmids, carrying either NDM-1, CTX-M-15, or OXA-48, which K. pneumoniae ST307 likely donated to other K. pneumoniae isolates of different STs and even other bacterial species (e.g., Enterobacter cloacae) within the clinical settings. Several chromosomally and plasmid-encoded, hypervirulence-associated virulence factors (e.g., yersiniabactin, metabolite transporter, aerobactin, and heavy metal resistance genes) were identified in addition. While growth, biofilm formation, desiccation resilience, serum survival, and heavy metal resistance were comparable to several control strains, results from siderophore secretion and hypermucoviscosity experiments revealed superiority of the ST307 clone, similar to an archetypical, hypervirulent K. pneumoniae strain (hvKP1).
Conclusions
The combination of extensive drug resistance and virulence, partly conferred through a “mosaic” plasmid carrying both antibiotic resistance and hypervirulence-associated features, demonstrates serious public health implications.

Kommentar
Hier konnte gezeigt werden, dass ein K. pneumoniae Ausbruchklon Antibiotikresistenzen gegen Reserveantibiotika mit Eigenschaften einer Hypervirulenz auf einem Plasmid miteinander kombiniert und dass dieses Plasmid zwischen verschiedenen Pathogenen übertragen wurde.

Kontakt
Stefan Heiden
stefan.heiden@uni-greifswald.de

Katharina Schaufler
katharina.schaufler@uni-greifswald.de
Institute of Pharmacy, Pharmaceutical Microbiology, University of Greifswald

Nils-Olaf Hübner
Central Unit for Infection Prevention and Control, University Medicine Greifswald nils.huebner@med.uni-greifswald.de