{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T17:25:34Z","timestamp":1791048334021,"version":"4.1.0"},"reference-count":37,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,3,4]],"date-time":"2025-03-04T00:00:00Z","timestamp":1741046400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Microbiol Spectr"],"published-print":{"date-parts":[[2025,3,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      Carbapenem-resistant\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      (CRKP) is a global public health threat, and CRKP strains carrying\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>NDM<\/jats:sub>\n                      plasmids are of particular concern. Here, the antimicrobial resistance and molecular epidemiological characteristics of 59 CRKP strains isolated from patients receiving care at a tertiary hospital in China from 2019 to 2021 were determined through antimicrobial resistance testing and genomic sequence analysis. We analyzed the genetic characteristics and transmissibility of\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>NDM<\/jats:sub>\n                      -harboring plasmids through S1-digested pulsed field gel electrophoresis, Southern blotting, and conjugation assays. The virulence levels of the strains were evaluated using a\n                      <jats:italic>Galleria mellonella<\/jats:italic>\n                      larvae infection model. All the CRKP strains were multidrug resistant, but none were resistant to colistin or tigecycline. A total of eight sequence types (STs) were detected in these CRKPs, with ST11 (39\/59) and ST15 (12\/59) being the most common. Among the carbapenemase genes,\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>KPC<\/jats:sub>\n                      (39\/59) and\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>NDM<\/jats:sub>\n                      (18\/59) were the most common, with\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>KPC-2<\/jats:sub>\n                      transmitted mainly through ST11 clones and\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>NDM-5<\/jats:sub>\n                      transmitted through ST15 clones. The\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>NDM<\/jats:sub>\n                      -harboring plasmids primarily belong to the incompatibility type IncX3 (14\/18). IS\n                      <jats:italic>26<\/jats:italic>\n                      -mediated gene recombination, sequence insertion, and plasmid integration were observed to occur during the dissemination process. The resistance gene profile mediated by\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>NDM<\/jats:sub>\n                      -harboring plasmids can be transferred through conjugation, which have almost no fitness cost and is extremely stable after passage. Six of these strains presented carbapenem resistance combined with hypervirulence (CR-hvKP), including ST23-KL1, ST218-KL57, ST17-KL112, and ST147-KL64. Additionally,\n                      <jats:italic>bla<\/jats:italic>\n                      <jats:sub>NDM<\/jats:sub>\n                      -harboring plasmids can disseminate rapidly over large surface areas and persist for a long time in medical institutions, leading to outbreaks of highly resistant clones associated with CR-hvKP.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        The appearance of plasmids carrying\n                        <jats:italic>bla<\/jats:italic>\n                        <jats:sub>NDM<\/jats:sub>\n                        and the rise of carbapenem-resistant hypervirulent\n                        <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                        (CR-hvKP) have significantly escalated the public health risk associated with Carbapenem-resistant\n                        <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                        (CRKP). In this study, we described the resistance rates, virulence factors, and molecular epidemiology of 59 CRKP isolated from patients at a tertiary hospital in China from 2019 to 2021. Beyond this, we also assessed the characteristics of\n                        <jats:italic>bla<\/jats:italic>\n                        <jats:sub>NDM<\/jats:sub>\n                        -harboring plasmids and their dissemination patterns among CRKP, especially some CR-hvKP. Our research contributes to the field of\n                        <jats:italic>bla<\/jats:italic>\n                        <jats:sub>NDM<\/jats:sub>\n                        dissemination studies, prompting researchers to formulate strict measures to prevent and control the development of\n                        <jats:italic>bla<\/jats:italic>\n                        <jats:sub>NDM<\/jats:sub>\n                        -harboring plasmids, which is instrumental in the clinical development of targeted treatment plans.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.01968-24","type":"journal-article","created":{"date-parts":[[2025,2,12]],"date-time":"2025-02-12T09:00:31Z","timestamp":1739350831000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":12,"title":["Dissemination of\n                    <i>bla<\/i>\n                    <sub>NDM<\/sub>\n                    -harboring plasmids in carbapenem-resistant and hypervirulent\n                    <i>Klebsiella pneumoniae<\/i>"],"prefix":"10.1128","volume":"13","author":[{"given":"Yihai","family":"Gu","sequence":"first","affiliation":[{"name":"Department of Microbiology, School of Medicine, Xi\u2019an Jiaotong University","place":["Hanzhong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Microbiology, School of Medicine, Xi\u2019an Jiaotong University","place":["Hanzhong, China"]},{"name":"Department of Laboratory Medicine, Chengdu 363 Hospital Affiliated to Southwest Medical University","place":["Chengdu, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Microbiology, School of Medicine, Xi\u2019an Jiaotong University","place":["Hanzhong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Weng","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiucheng","family":"Shi","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Hou","sequence":"additional","affiliation":[{"name":"Department of Microbiology, School of Medicine, Xi\u2019an Jiaotong University","place":["Hanzhong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Microbiology, School of Medicine, Xi\u2019an Jiaotong University","place":["Hanzhong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minghui","family":"Deng","sequence":"additional","affiliation":[{"name":"Department of Microbiology, School of Medicine, Xi\u2019an Jiaotong University","place":["Hanzhong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jian","family":"Mou","sequence":"additional","affiliation":[{"name":"Department of Microbiology, School of Medicine, Xi\u2019an Jiaotong University","place":["Hanzhong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5877-9286","authenticated-orcid":true,"given":"Yan","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine","place":["Hangzhou, 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