{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,22]],"date-time":"2026-08-22T00:47:02Z","timestamp":1787359622178,"version":"build-2736575974"},"reference-count":37,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T00:00:00Z","timestamp":1741824000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cell. Infect. Microbiol."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p><jats:italic>Klebsiella pneumoniae<\/jats:italic> is one of the main pathogens of nosocomial infection, among which carbapenems can be used for multidrug-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic>. However, in the past decade, the resistance rate of carbapenem-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic> has increased yearly. Tigecycline has good antibacterial activity in treating severe bacterial infections, but the reports of tigecycline resistance are increasing. This study aimed to investigate the mechanism of drug resistance and epidemiological characteristics of tigecycline-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic> (TRKP) in a large teaching hospital in southwest China, Chongqing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We isolated 30 TRKP strains from this hospital between August 2021 and December 2023. By PCR and sequencing, we examined the presence and mutation rates of genes associated with tigecycline resistance, including <jats:italic>acrR, oqxR, ramR, tmexC, tet(x), tet(A), tet(L)<\/jats:italic>, and <jats:italic>rpsj<\/jats:italic>, and performed efflux pump inhibition experiments to verify efflux pump activity. At the same time, real-time RT-PCR was used to detect the expression levels of efflux pump genes (<jats:italic>acrB<\/jats:italic> and <jats:italic>oqxB<\/jats:italic>) and <jats:italic>ramA.<\/jats:italic> To investigate the prevalence trend of TRKP in our hospital, we performed multi-site sequence typing (MLST) analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mutation rates of <jats:italic>ramR<\/jats:italic> (73.3%) and <jats:italic>tet(A)<\/jats:italic> (63.3%) were significant. In efflux pump inhibition experiments, Pa\u03b2N could reverse the resistance of 29 TRKP strains (96.7%) to tigecycline. Real-time RT-PCR results showed that <jats:italic>acrB<\/jats:italic> and <jats:italic>ramA<\/jats:italic> genes were up-regulated in 22 strains, while <jats:italic>oqxB<\/jats:italic> genes were overexpressed in only 4 strains. MLST analysis showed that these strains could be divided into 25 different ST subtypes, indicating that no outbreak of TRKP occurred in our hospital. In addition, two tmexCD-torpj positive strains, ST661 and ST1561, were identified for the first time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The efflux pump <jats:italic>acrB<\/jats:italic> and <jats:italic>tet(A)<\/jats:italic> mutations are the primary mechanisms of resistance to <jats:italic>tigecycline-resistant Klebsiella pneumoniae<\/jats:italic> at our hospital. The <jats:italic>ramR<\/jats:italic> mutation can mediate efflux pump activity of <jats:italic>acrB<\/jats:italic> by up-regulating <jats:italic>ramA<\/jats:italic> overexpression.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2025.1540967","type":"journal-article","created":{"date-parts":[[2025,3,13]],"date-time":"2025-03-13T07:07:05Z","timestamp":1741849625000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["The investigation of molecular epidemiological characteristics and resistance mechanism of tigecycline resistant Klebsiella pneumoniae from a large teaching hospital in southwest China, Chongqing"],"prefix":"10.3389","volume":"15","author":[{"given":"Yuqiong","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shiyu","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peiwen","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingting","family":"Si","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Song","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun","family":"Xia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,3,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1304","DOI":"10.3390\/antibiotics12081304","article-title":"The art of war with pseudomonas aeruginosa: targeting mex efflux pumps directly to strategically enhance antipseudomonal drug efficacy","volume":"12","author":"Avakh","year":"2023","journal-title":"Antibiotics (Basel)"},{"key":"B2","doi-asserted-by":"publisher","first-page":"5561","DOI":"10.1128\/aac.00547-15","article-title":"The ribosomal S10 protein is a general target for decreased tigecycline susceptibility","volume":"59","author":"Beabout","year":"2015","journal-title":"Antimicrob. 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