{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:40:57Z","timestamp":1785404457005,"version":"3.56.0"},"reference-count":45,"publisher":"American Society for Microbiology","issue":"3","license":[{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:00:00Z","timestamp":1772496000000},"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":[[2026,3,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title\/>\n                    <jats:p>\n                      The emergence of carbapenem-resistant hypervirulent\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      (CR-hvKP), particularly strains co-producing dual carbapenemases such as\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      carbapenemase (KPC) and New Delhi metallo-\u03b2-lactamase (NDM), poses a significant challenge in clinical settings. This study aimed to elucidate the clinical features, molecular epidemiology, virulence phenotype, and plasmid stability of ST11-KL64-type\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      co-producing KPC-2 and NDM-1. We retrospectively analyzed 44 non-duplicate clinical isolates of KPC-2-NDM-1-carbapenem-resistant\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      (K2N1-CRKP) and their corresponding clinical data from patients in a Chinese teaching hospital in 2021. Comprehensive analyses included antimicrobial susceptibility testing, pulsed-field gel electrophoresis (PFGE), whole-genome sequencing, serum killing assays,\n                      <jats:italic toggle=\"yes\">Galleria mellonella<\/jats:italic>\n                      infection models, and plasmid stability experiments. All isolates were resistant to carbapenems and ceftazidime\/avibactam. These strains belonged to the ST11-KL64-O1\/O2v1 clone and showed high genetic relatedness (\u226588% similarity) via PFGE. Among them, 79.55% (35\/44) were classified as CR-hvKP, carrying the virulence genes\n                      <jats:italic toggle=\"yes\">iucABCD<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">rmpA<\/jats:italic>\n                      \/\n                      <jats:italic toggle=\"yes\">rmpA2<\/jats:italic>\n                      . Genomic analysis revealed that\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>KPC-2<\/jats:sub>\n                      and\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>NDM-1<\/jats:sub>\n                      were located on an IncFII\/IncR plasmid and an untypable plasmid, respectively, while the virulence gene cluster was identified on an IncFIB\/IncHI1B virulence plasmid. The virulence phenotypes of selected strains exhibited heterogeneity. One isolate (KP1225) demonstrated high virulence\n                      <jats:italic toggle=\"yes\">in vitro<\/jats:italic>\n                      and\n                      <jats:italic toggle=\"yes\">in vivo<\/jats:italic>\n                      . Notably, these strains maintained their resistance plasmids without antibiotic pressure (retention rate &gt;85% after 10 days), with no significant fitness cost observed. This study reveals a clonal dissemination of ST11-KL64-K2N1-CR-hvKP, successfully integrating carbapenem resistance and hypervirulence with high genetic stability. The potential risk of its spread warrants urgent attention and effective infection control measures.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>IMPORTANCE<\/jats:title>\n                    <jats:p>\n                      The emergence of bacterial pathogens that combine hypervirulence with advanced antimicrobial resistance poses a significant challenge for modern healthcare. This study comprehensively analyzes a concerning clinical strain: ST11-KL64\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      co-harboring both KPC-2 and NDM-1 carbapenemases. We demonstrate that this strain successfully integrates multiple resistance mechanisms, hypervirulence determinants, and remarkable genetic stability without observable fitness costs\u2014a combination that significantly complicates treatment and infection control. Critically, the stable maintenance of its resistance plasmids without antibiotic selection highlights the potential for persistent colonization and transmission. These findings underscore an evolving threat in the landscape of multidrug-resistant infections and emphasize the urgent need for enhanced surveillance, robust diagnostic approaches, and novel therapeutic strategies to address such challenging pathogens.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.02911-25","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T14:02:22Z","timestamp":1770645742000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":0,"title":["Clinical characteristics and molecular evolution of ST11-KL64 carbapenem-resistant hypervirulent\n                    <i>Klebsiella pneumoniae<\/i>\n                    co-producing KPC-2 and NDM-1 from China"],"prefix":"10.1128","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-4572-5136","authenticated-orcid":false,"given":"Letian","family":"Xia","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, The Second Affiliated Hospital of Xuzhou Medical University","place":["Xuzhou, People's Republic of China"]},{"name":"School of Medical Technology, Xuzhou Medical University","place":["Xuzhou, People's Republic of China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8853-2868","authenticated-orcid":false,"given":"Mengjiao","family":"Shi","sequence":"additional","affiliation":[{"name":"School of Medical Technology, Xuzhou Medical University","place":["Xuzhou, People's Republic of 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