{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T15:47:37Z","timestamp":1792424857394,"version":"4.5.0"},"reference-count":52,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T00:00:00Z","timestamp":1748995200000},"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>Objectives<\/jats:title><jats:p>Carbapenem-resistant hypervirulent <jats:italic>Klebsiella pneumoniae<\/jats:italic> (CR-hvKP) poses a significant public health challenge. This study investigated the molecular epidemiology, antimicrobial resistance patterns, clinical characteristics, and risk factors of CR-hvKP infection in Huaian, China.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We retrospectively studied patients infected with carbapenem-resistant <jats:italic>K. pneumoniae<\/jats:italic> (CRKP) between November 2022 and September 2024. Whole-genome sequencing was used to detect carbapenemase, virulence, capsular serotype-related genes, and plasmid types in 374 CRKP isolates.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among them, 57.49% (215\/374) strains met the criteria for CR-hvKP. The most common type was blaKPC-2-producing ST11(98.60%, 212\/215), whereas K64 (56.74%, 122\/215) and KL25 (39.53%, 85\/215) were the main capsular serotypes. The CR-hvKP strains showed significantly higher resistance to the tested antibiotics, except for ceftazidime\/avibactam and colistin. Resistance rates of CR-hvKP to the three tested antibiotics (minocycline, cotrimoxazole, and amikacin) were higher than those of CRnon-hvKP. Phylogenetic analysis based on whole-genome single-nucleotide polymorphisms divided the 251 isolates into four independent branches, with branch 2 being the most prevalent, indicating high clonality among the strains. Multivariate analysis showed diabetes [odds ratio (OR) = 3.771] and surgery (OR =2.042) to be independent variables associated with CR-hvKP infection.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Notably, the ST11 lineage carrying blaKPC-2 has emerged as a dominant high-risk clone in Huaian. Given the wide distribution of these novel CR-hvKP isolates, global monitoring and stricter control measures should be implemented to prevent their further spread in hospital settings.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcimb.2025.1569004","type":"journal-article","created":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T05:36:37Z","timestamp":1749015397000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Molecular and epidemiological characterization of carbapenem-resistant hypervirulent Klebsiella pneumoniae in Huaian, China (2022\u20132024): a retrospective study"],"prefix":"10.3389","volume":"15","author":[{"given":"Jianchun","family":"Lian","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qianhui","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng","family":"Peng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tao","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hong","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chaogui","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaoyun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,6,4]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"3895","DOI":"10.1128\/aac.02412-14","article-title":"In silico detection and typing of plasmids using PlasmidFinder and plasmid multilocus sequence typing","volume":"58","author":"Carattoli","year":"2014","journal-title":"Antimicrob. Agents Chemother."},{"key":"B2","doi-asserted-by":"publisher","first-page":"3483","DOI":"10.1128\/jcm.00726-14","article-title":"First isolate of KPC-2-producing Klebsiella pneumonaie sequence type 23 from the Americas","volume":"52","author":"Cejas","year":"2014","journal-title":"J. Clin. Microbiol."},{"key":"B3","volume-title":"Performance standards for antimicrobial susceptibility testing; 31th informational supplement (CLSI M100-S31)","year":"2021"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.01365","article-title":"Reduced ceftazidime-avibactam susceptibility in KPC-producing klebsiella pneumoniae from patients without ceftazidime-avibactam use history - A multicenter study in China","volume":"11","author":"Cui","year":"2020","journal-title":"Front. Microbiol."},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1002\/0471250953.bi1003s00","article-title":"Using MUMmer to identify similar regions in large sequence sets","volume":"10","author":"Delcher","year":"2003","journal-title":"Curr. Protoc. Bioinf."},{"key":"B6","volume-title":"Breakpoint tables for interpretation of MICs and zone diameters. version 11.0","year":"2021"},{"key":"B7","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1084\/jem.20030857","article-title":"A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications","volume":"199","author":"Fang","year":"2004","journal-title":"J. Exp. Med."},{"key":"B8","doi-asserted-by":"publisher","first-page":"297","DOI":"10.1016\/j.amjms.2015.12.018","article-title":"Klebsiella pneumoniae liver abscess: an emerging disease","volume":"351","author":"Fazili","year":"2016","journal-title":"Am. J. Med. Sci."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1322","DOI":"10.3201\/eid1808.111053","article-title":"Klebsiella pneumoniae in gastrointestinal tract and pyogenic liver abscess","volume":"18","author":"Fung","year":"2012","journal-title":"Emerg. Infect. Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/s1473-3099(17)30489-9","article-title":"A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study","volume":"18","author":"Gu","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2020.00314","article-title":"Dissemination of carbapenemases (KPC, NDM, OXA-48, IMP, and VIM) among carbapenem-resistant enterobacteriaceae isolated from adult and children patients in China","volume":"10","author":"Han","year":"2020","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1001","DOI":"10.1016\/j.cmi.2015.07.001","article-title":"Tracking a hospital outbreak of KPC-producing ST11 Klebsiella pneumoniae with whole genome sequencing","volume":"21","author":"Jiang","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1080\/21505594.2020.1809325","article-title":"Neutrophil extracellular traps (NETs)-mediated killing of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) are impaired in patients with diabetes mellitus","volume":"11","author":"Jin","year":"2020","journal-title":"Virulence"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1128\/aac.02435-20","article-title":"Identification of a novel hybrid plasmid encoding KPC-2 and virulence factors in klebsiella pneumoniae sequence type 11","volume":"65","author":"Jin","year":"2021","journal-title":"Antimicrob. Agents Chemother."},{"key":"B15","doi-asserted-by":"publisher","first-page":"750","DOI":"10.1128\/mmbr.00015-09","article-title":"Pathogenomics of the virulence plasmids of Escherichia coli","volume":"73","author":"Johnson","year":"2009","journal-title":"Microbiol. Mol. Biol. Rev."},{"key":"B16","doi-asserted-by":"publisher","first-page":"S81","DOI":"10.1086\/653053","article-title":"Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia","author":"Jones","year":"2010","journal-title":"Clin. Infect. Dis."},{"key":"B17","doi-asserted-by":"publisher","first-page":"1725","DOI":"10.1128\/jcm.25.9.1725-1729.1987","article-title":"In vitro antimicrobial spectrum, occurrence of synergy, and recommendations for dilution susceptibility testing concentrations of the cefoperazone-sulbactam combination","volume":"25","author":"Jones","year":"1987","journal-title":"J. Clin. Microbiol."},{"key":"B18","doi-asserted-by":"publisher","first-page":"600","DOI":"10.1097\/PAT.0b013e3283650b1e","article-title":"Acquired carbapenemases in enterobactericeae in Singapore 1996-2012","volume":"45","author":"Koh","year":"2013","journal-title":"Pathology"},{"key":"B19","doi-asserted-by":"publisher","first-page":"1547","DOI":"10.1093\/molbev\/msy096","article-title":"MEGA X: molecular evolutionary genetics analysis across computing platforms","volume":"35","author":"Kumar","year":"2018","journal-title":"Mol. Biol. Evol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"4188","DOI":"10.1038\/s41467-021-24448-3","article-title":"A genomic surveillance framework and genotyping tool for Klebsiella pneumoniae and its related species complex","volume":"12","author":"Lam","year":"2021","journal-title":"Nat. Commun."},{"key":"B21","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1111\/j.1365-2796.2006.01641.x","article-title":"Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates: association with invasive syndrome in patients with community-acquired bacteraemia","volume":"259","author":"Lee","year":"2006","journal-title":"J. Intern. Med."},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2017.00483","article-title":"Antimicrobial resistance of hypervirulent klebsiella pneumoniae: epidemiology, hypervirulence-associated determinants, and resistance mechanisms","volume":"7","author":"Lee","year":"2017","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B23","doi-asserted-by":"publisher","first-page":"e688","DOI":"10.1016\/j.ijid.2010.01.007","article-title":"Hypermucoviscosity associated with Klebsiella pneumoniae-mediated invasive syndrome: a prospective cross-sectional study in Taiwan","volume":"14","author":"Lee","year":"2010","journal-title":"Int. J. Infect. Dis."},{"key":"B24","doi-asserted-by":"publisher","first-page":"W78","DOI":"10.1093\/nar\/gkae268","article-title":"Interactive Tree of Life (iTOL) v6: recent updates to the phylogenetic tree display and annotation tool","volume":"52","author":"Letunic","year":"2024","journal-title":"Nucleic Acids Res."},{"key":"B25","doi-asserted-by":"publisher","first-page":"679","DOI":"10.1007\/s10096-017-3160-z","article-title":"Risk factors and clinical outcomes of hypervirulent Klebsiella pneumoniae induced bloodstream infections","volume":"37","author":"Li","year":"2018","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"B26","doi-asserted-by":"publisher","first-page":"225","DOI":"10.1093\/cid\/cit675","article-title":"Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China","volume":"58","author":"Li","year":"2014","journal-title":"Clin. Infect. Dis."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2180-11-50","article-title":"Assessment of hypermucoviscosity as a virulence factor for experimental Klebsiella pneumoniae infections: comparative virulence analysis with hypermucoviscosity-negative strain","volume":"11","author":"Lin","year":"2011","journal-title":"BMC Microbiol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"1913","DOI":"10.1001\/archinte.1986.00360220057011","article-title":"Klebsiella pneumoniae liver abscess associated with septic endophthalmitis","volume":"146","author":"Liu","year":"1986","journal-title":"Arch. Intern. Med."},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2018.00004","article-title":"Colonization, infection, and the accessory genome of klebsiella pneumoniae","volume":"8","author":"Martin","year":"2018","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"3025","DOI":"10.1093\/jac\/dkx264","article-title":"Covert dissemination of carbapenemase-producing Klebsiella pneumoniae (KPC) in a successfully controlled outbreak: long- and short-read whole-genome sequencing demonstrate multiple genetic modes of transmission","volume":"72","author":"Martin","year":"2017","journal-title":"J. Antimicrob. Chemother."},{"key":"B31","doi-asserted-by":"publisher","first-page":"171","DOI":"10.1080\/1120009x.2020.1761172","article-title":"Evaluation of the synergy of ceftazidime\/avibactam in combination with colistin, doripenem, levofloxacin, tigecycline, and tobramycin against OXA-48 producing Enterobacterales","volume":"32","author":"Mataraci Kara","year":"2020","journal-title":"J. Chemother."},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.1016\/j.compbiolchem.2020.107380","article-title":"Identification of novel vaccine candidates against carbapenem resistant Klebsiella pneumoniae: A systematic reverse proteomic approach","volume":"89","author":"Mehmood","year":"2020","journal-title":"Comput. Biol. Chem."},{"key":"B33","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1089\/mdr.2021.0156","article-title":"Molecular epidemiology, microbial virulence, and resistance of carbapenem-resistant enterobacterales isolates in a teaching hospital in Guangzhou, China","volume":"28","author":"Peng","year":"2022","journal-title":"Microb. Drug Resist."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e190","DOI":"10.1016\/s1473-3099(16)30021-4","article-title":"Primary osteomyelitis caused by hypervirulent Klebsiella pneumoniae","volume":"16","author":"Prokesch","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.1128\/cmr.00001-19","article-title":"Hypervirulent klebsiella pneumoniae","volume":"32","author":"Russo","year":"2019","journal-title":"Clin. Microbiol. Rev."},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1128\/jcm.00776-18","article-title":"Identification of Biomarkers for Differentiation of Hypervirulent Klebsiella pneumoniae from Classical K. pneumoniae","volume":"56","author":"Russo","year":"2018","journal-title":"J. Clin. Microbiol."},{"key":"B37","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1080\/21505594.2015.1135289","article-title":"Galleria mellonella infection models for the study of bacterial diseases and for antimicrobial drug testing","volume":"7","author":"Tsai","year":"2016","journal-title":"Virulence"},{"key":"B38","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.micpath.2017.01.049","article-title":"Bacteremia and other body site infection caused by hypervirulent and classic Klebsiella pneumoniae","volume":"104","author":"Wu","year":"2017","journal-title":"Microb. Pathog."},{"key":"B39","doi-asserted-by":"publisher","first-page":"344","DOI":"10.1038\/s41579-019-0315-1","article-title":"Population genomics of Klebsiella pneumoniae","volume":"18","author":"Wyres","year":"2020","journal-title":"Nat. Rev. Microbiol."},{"key":"B40","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1016\/j.tim.2020.04.012","article-title":"Carbapenem resistance-encoding and virulence-encoding conjugative plasmids in klebsiella pneumoniae","volume":"29","author":"Yang","year":"2021","journal-title":"Trends Microbiol."},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.01610","article-title":"Molecular Characterization of an IncFII(k) Plasmid Co-harboring bla (IMP-26) and tet(A) Variant in a Clinical Klebsiella pneumoniae Isolate","volume":"11","author":"Yao","year":"2020","journal-title":"Front. Microbiol."},{"key":"B42","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1016\/j.ijid.2015.06.023","article-title":"Clinical and molecular characteristics of multi-clone carbapenem-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in a tertiary hospital in Beijing, China","volume":"37","author":"Yao","year":"2015","journal-title":"Int. J. Infect. Dis."},{"key":"B43","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.diagmicrobio.2008.04.007","article-title":"Comparison of prevalence of virulence factors for Klebsiella pneumoniae liver abscesses between isolates with capsular K1\/K2 and non-K1\/K2 serotypes","volume":"62","author":"Yu","year":"2008","journal-title":"Diagn. Microbiol. Infect. Dis."},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1016\/j.micpath.2019.103647","article-title":"Emergence of hypervirulent K. pneumoniae causing complicated UTI in kidney stone patients","volume":"135","author":"Zafar","year":"2019","journal-title":"Microb. Pathog."},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2017.00182","article-title":"Outbreak by hypermucoviscous klebsiella pneumoniae ST11 isolates with carbapenem resistance in a tertiary hospital in China","volume":"7","author":"Zhan","year":"2017","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B46","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1093\/jac\/dkz446","article-title":"Evolution of hypervirulence in carbapenem-resistant Klebsiella pneumoniae in China: a multicentre, molecular epidemiological analysis","volume":"75","author":"Zhang","year":"2020","journal-title":"J. Antimicrob. Chemother."},{"key":"B47","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1128\/aac.02173-15","article-title":"Emergence of carbapenem-resistant serotype K1 hypervirulent klebsiella pneumoniae strains in China","volume":"60","author":"Zhang","year":"2016","journal-title":"Antimicrob. Agents Chemother."},{"key":"B48","doi-asserted-by":"publisher","first-page":"98","DOI":"10.1016\/j.ebiom.2017.04.032","article-title":"Nationwide surveillance of clinical carbapenem-resistant enterobacteriaceae (CRE) strains in China","volume":"19","author":"Zhang","year":"2017","journal-title":"EBioMedicine"},{"key":"B49","doi-asserted-by":"publisher","first-page":"124.e121","DOI":"10.1016\/j.cmi.2019.08.020","article-title":"Emergence of ceftazidime\/avibactam resistance in carbapenem-resistant Klebsiella pneumoniae in China","volume":"26","author":"Zhang","year":"2020","journal-title":"Clin. Microbiol. Infect."},{"key":"B50","doi-asserted-by":"publisher","first-page":"553","DOI":"10.1016\/j.jinf.2015.07.010","article-title":"Emergence of a hypervirulent carbapenem-resistant Klebsiella pneumoniae isolate from clinical infections in China","volume":"71","author":"Zhang","year":"2015","journal-title":"J. Infect."},{"key":"B51","doi-asserted-by":"publisher","first-page":"403","DOI":"10.2147\/idr.S392947","article-title":"Characterization of hypervirulent and carbapenem-resistant K. pneumoniae isolated from neurological patients","volume":"16","author":"Zhou","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"B52","doi-asserted-by":"publisher","first-page":"289","DOI":"10.3201\/eid2602.190594","article-title":"Novel subclone of carbapenem-resistant klebsiella pneumoniae sequence type 11 with enhanced virulence and transmissibility, China","volume":"26","author":"Zhou","year":"2020","journal-title":"Emerg. Infect. Dis."}],"container-title":["Frontiers in Cellular and Infection Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2025.1569004\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,6,4]],"date-time":"2025-06-04T05:36:39Z","timestamp":1749015399000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2025.1569004\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,4]]},"references-count":52,"alternative-id":["10.3389\/fcimb.2025.1569004"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2025.1569004","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,4]]},"article-number":"1569004"}}