Table 2.
A non-exhaustive listing of recent clinical isolates demonstrating multidrug resistance and hypervirulence
| Location | Sequence Type (ST) |
Capsule (K) | Clinical context | Notesa | Ref |
|---|---|---|---|---|---|
| Classical strains that acquired virulence genes | |||||
| China | ST11 | K47 | Ventilator-associated pneumonia | 5 isolates; widespread resistance; HMV+, 170 kb pLVPK-like plasmid of ST43. Retrospective analysis suggested ST11 isolates acquired virulence multiple times | [55] |
| ST11 | K47 | Retrospective study | pLVPK-like plasmid and two AR plasmids; unique feature of five tandem copies of blaKPC-2 | [174] | |
| India | ST147 | K54 | Sepsis and kidney injury | HMV+, limited acquisition of virulence genes, colistin resistant | [175] |
| United States | ST258 | K107 | Retrospective study | HMV+/rmpA−, a few virulence genes on hybrid AR plasmid; chromosomal siderophore receptor genes | [152] |
| Norway | ST15 | Two bacteremia isolates | 300 or 346 kb mosaic plasmids of pK2044-like virulence plasmid and conjugative AR plasmid | [176] | |
| China | ST15 | Elderly patients with pneumonia and other lung trauma | Clonal expansion of blaOXA-232 encoding isolate; virulence genes detected but not hypervirulent in laboratory models | [177] | |
| hvKp isolates acquiring resistance | |||||
| China | ST23 | K1 | Two bloodstream isolates | blaSHV-36 with colistin resistance in addition to pLVPK-like plasmid and canonical virulence genes | [178] |
| China | ST23 | K1 | Bloodstream, kidney abscess | Hybrid of pLVPK-like virulence plasmid with transposon-mediated integration of blaCTX-M-24 | [160] |
| United States | ST23 | K1 | Urine sample | blaSHV-36, fosA, oqxAB on chromosome; AR plasmid with blaKPC-2, blaTEM-1A and truncated blaOXA-9 | [153] |
| China | ST23 | K1 | Sepsis | pLVPK-like virulence plasmid with insertion of blaKPC-2 and dfrA14 genes | [158] [12] |
| China | ST36 | K62 | Bloodstream; burn wounds | pLVPK-like plasmid and AR plasmid encoding blaKPC-2, fosA, oqxAB, along with resistance to aminoglycosides, macrolides, sulfonamides and others | [179] |
| China | ST65 | K2 | Meningitis | Most canonical virulence genes on chromosome and pLVPK-like plasmid; encodes blaSHV-11, blaTEM-1, blaCTx-M-3, blaCTX-M-4 | [180] |
| China | ST65 | K2 | Infant bloodstream | Encodes ent and iuc but not ybt or kfu; hypervirulent in mouse model; blaSHV-11, blaTEM-53, decreased expression of ompK35/36 | [155] |
| France | ST86 | K2 | Carriage | Encodes blaCTX-M-3 | [150] |
| China | ST86 | K2 | Burn wound | blaKPC-2 and blaNDM-1; 215 kb virulence plasmid | [181] |
| Canada | ST86 | KL2 | UTI | pLVPK-like plasmid; plasmid with blaKPC-2 as well as blaSHV-1 and fosA | [182] |
AR, antimicrobial resistance; bla, beta-lactamase provides resistance to penicillins, first- and second-generation cephalosporins; blaCTX-M-24, blaCTX-M-3 and blaCTX-M-4, ESBLs with particular activity against cefotaxime; blaKPC-2, bla (K. pneumoniae carbapenem resistance) with carbapenemase activity; blaNDM-1, bla (New Delhi metallo-bla) with carbapenemase activity; blaOXA-32 and blaOXA-9, ESBLs with particular activity against oxacillin; blaSHV-36 and blaSHV-11, ESBLs; blaTEM-1A, blaTEM-1, and blaTEM-53, ESBLs; dfrA14, trimethoprim resistance gene; ESBL, extended-spectrum beta-lactamase provides additional resistance to monobactams and third-generation cephalosporins; fosA, fosfomycin resistance gene; kb, kilobase, length of DNA molecule; ompK35/36 outer membrane porins that allow entry carbapenems and cephalosporins, reduced expression increases resistance; oqxAB, resistance to olaquindox and some quinolones.