{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T03:39:13Z","timestamp":1791517153934,"version":"4.3.4"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T00:00:00Z","timestamp":1766102400000},"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:p>\n                    Carbapenem-resistant\n                    <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                    (CRKP) readily colonizes clinical environments as well as the respiratory and intestinal tracts of patients and can easily cause secondary infections, posing a serious threat to infection treatment and hospital infection control. In this study, we continuously tracked CRKP strains isolated from a single patient over a total of 16 weeks\u2014from admission to the ICU until discharge from the general ward. A total of 21 CRKP strains were obtained, including 1 bloodstream infection (BSI) isolate, 8 respiratory tract colonization isolates, and 12 intestinal colonization isolates. All isolates were evaluated for their phenotypic characteristics related to antimicrobial resistance, pathogenicity, and plasmid transfer through antimicrobial susceptibility testing, mouse infection models, and conjugation experiments. In parallel, whole-genome sequencing was performed to determine their MLST types, capsular serotypes, resistance and virulence genes, and plasmid profiles. The results showed that these isolates belonged to two distinct clones. One BSI isolate, along with one respiratory and one intestinal colonization isolate, belonged to the ST268 with capsular serotype KL20. This clone carried not only the typical hypervirulence (hv) genes\n                    <jats:italic>aerobactin<\/jats:italic>\n                    ,\n                    <jats:italic>colibactin<\/jats:italic>\n                    , and\n                    <jats:italic>rmpA2<\/jats:italic>\n                    but also a plasmid encoding\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>KPC-2<\/jats:sub>\n                    , representing a classic CR-hvKP strain. Mouse infection models confirmed its high virulence. The remaining isolates belonged to the ST4496 clone, a member of the CC11 clonal complex commonly found in ICU outbreaks, with serotype KL47, exhibiting lower pathogenicity but carrying the same\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>KPC-2<\/jats:sub>\n                    -harboring plasmid as ST268, indicating horizontal plasmid transfer. In-host co-colonization by the distinct CRKP clones ST4496 and ST268 may have facilitated horizontal transfer of the\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>KPC-2<\/jats:sub>\n                    -harboring plasmid, enabling ST268 to evolve from hvKP into CR-hvKP and subsequently cause secondary BSI. This process, in which pathogen clones with different traits co-colonize and mutually promote evolutionary changes, may interfere with clinical treatment decisions and underscores the need for more intensive hospital infection surveillance.\n                  <\/jats:p>","DOI":"10.3389\/fcimb.2025.1683743","type":"journal-article","created":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T06:27:05Z","timestamp":1766125625000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["In-host co-colonization and bloodstream infection by distinct classical and hypervirulent CRKP clones harboring a homologous blaKPC-2-harboring plasmid"],"prefix":"10.3389","volume":"15","author":[{"given":"Haixing","family":"Fang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yueliang","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Qi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rushuang","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feng","family":"Guo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,12,19]]},"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":"1611","DOI":"10.3390\/microorganisms12122548","article-title":"A decade-long review of the virulence, resistance, and epidemiological risks of klebsiella pneumoniae in ICUs","volume":"12","author":"Chen","year":"2024","journal-title":"Microorganisms"},{"key":"B3","doi-asserted-by":"publisher","first-page":"e0408822","DOI":"10.1128\/spectrum.04088-22","article-title":"Association between intestinal colonization and extraintestinal infection with carbapenem-resistant klebsiella pneumoniae in children","volume":"11","author":"Du","year":"2023","journal-title":"Microbiol. Spectr."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2025","DOI":"10.1093\/jac\/dkaf170","article-title":"Real-time FT-IR typing of Klebsiella pneumoniae: a flexible and rapid approach for outbreak detection and infection control","volume":"80","author":"Goncalves","year":"2025","journal-title":"J. Antimicrob. Chemother."},{"key":"B5","doi-asserted-by":"publisher","first-page":"W484","DOI":"10.1093\/nar\/gkad326","article-title":"Proksee: in-depth characterization and visualization of bacterial genomes","volume":"51","author":"Grant","year":"2023","journal-title":"Nucleic Acids Res."},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2022.1003783","article-title":"Epidemiological characteristics and molecular evolution mechanisms of carbapenem-resistant hypervirulent Klebsiella pneumoniae","volume":"13","author":"Han","year":"2022","journal-title":"Front. Microbiol."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e0092423","DOI":"10.1128\/msystems.00924-23","article-title":"Genome sequencing unveils bla(KPC-2)-harboring plasmids as drivers of enhanced resistance and virulence in nosocomial Klebsiella pneumoniae","volume":"9","author":"Han","year":"2024","journal-title":"mSystems"},{"key":"B8","doi-asserted-by":"publisher","first-page":"1840","DOI":"10.1017\/ice.2022.4","article-title":"Poor outcomes in both infection and colonization with carbapenem-resistant Enterobacterales","volume":"43","author":"Howard-Anderson","year":"2022","journal-title":"Infect. Control. Hosp. Epidemiol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"S263","DOI":"10.1093\/infdis\/jiz562","article-title":"Core genome allelic profiles of clinical klebsiella pneumoniae strains using a random forest algorithm based on multilocus sequence typing scheme for hypervirulence analysis","volume":"221","author":"Lan","year":"2020","journal-title":"J. Infect. Dis."},{"key":"B10","doi-asserted-by":"publisher","first-page":"3027","DOI":"10.1016\/j.scib.2023.10.038","article-title":"Chasing the landscape for intrahospital transmission and evolution of hypervirulent carbapenem-resistant Klebsiella pneumoniae","volume":"68","author":"Liu","year":"2023","journal-title":"Sci. Bull. (Beijing)."},{"key":"B11","doi-asserted-by":"publisher","first-page":"D687","DOI":"10.1093\/nar\/gky1080","article-title":"VFDB 2019: a comparative pathogenomic platform with an interactive web interface","volume":"47","author":"Liu","year":"2019","journal-title":"Nucleic Acids Res."},{"key":"B12","doi-asserted-by":"publisher","first-page":"2271","DOI":"10.1038\/s41598-018-38295-8","article-title":"Assessing molecular epidemiology of carbapenem-resistant klebsiella pneumoniae (CR-KP) with MLST and MALDI-TOF in central China","volume":"9","author":"Meng","year":"2019","journal-title":"Sci. Rep."},{"key":"B13","doi-asserted-by":"publisher","first-page":"S206","DOI":"10.1093\/infdis\/jiz622","article-title":"The colonization of carbapenem-resistant klebsiella pneumoniae: epidemiology, resistance mechanisms, and risk factors in patients admitted to intensive care units in China","volume":"221","author":"Qin","year":"2020","journal-title":"J. Infect. Dis."},{"key":"B14","doi-asserted-by":"publisher","first-page":"1","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":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.01199","article-title":"Hypervirulence markers among non-ST11 strains of carbapenem- and multidrug-resistant klebsiella pneumoniae isolated from patients with bloodstream infections","volume":"11","author":"Shen","year":"2020","journal-title":"Front. Microbiol."},{"key":"B16","doi-asserted-by":"publisher","first-page":"2292","DOI":"10.1093\/jac\/dkae227","article-title":"Epidemiology of carbapenem-resistant Klebsiella pneumoniae in China and the evolving trends of predominant clone ST11: a multicentre, genome-based study","volume":"79","author":"Shi","year":"2024","journal-title":"J. Antimicrob. Chemother."},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2022.964290","article-title":"Emergence of K1 ST23 and K2 ST65 hypervirulent klebsiella pneumoniae as true pathogens with specific virulence genes in cryptogenic pyogenic liver abscesses Shiraz Iran","volume":"12","author":"Sohrabi","year":"2022","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B18","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2024.105331","article-title":"What defines hypervirulent Klebsiella pneumoniae","volume":"108","author":"Stanton","year":"2024","journal-title":"EBioMedicine"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2019.00230","article-title":"Dynamic colonization of klebsiella pneumoniae isolates in gastrointestinal tract of intensive care patients","volume":"10","author":"Sun","year":"2019","journal-title":"Front. Microbiol."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1936","DOI":"10.1080\/22221751.2022.2103454","article-title":"Prevalence of hypervirulent and carbapenem-resistant Klebsiella pneumoniae under divergent evolutionary patterns","volume":"11","author":"Tian","year":"2022","journal-title":"Emerg. Microbes Infect."},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.752011","article-title":"Acquisition of the conjugative virulence plasmid from a CG23 hypervirulent klebsiella pneumoniae strain enhances bacterial virulence","volume":"11","author":"Tian","year":"2021","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"326","DOI":"10.3390\/microorganisms7090326","article-title":"Hybrid Resistance and Virulence Plasmids in \u201cHigh-Risk\u201d Clones of Klebsiella pneumoniae, Including Those Carrying bla(NDM-5)","volume":"7","author":"Turton","year":"2019","journal-title":"Microorganisms"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/2615753","article-title":"Molecular epidemiology of carbapenem-resistant klebsiella pneumoniae in a tertiary hospital in northern China","volume":"2022","author":"Wang","year":"2022","journal-title":"Can. J. Infect. Dis. Med. Microbiol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"e1005595","DOI":"10.1371\/journal.pcbi.1005595","article-title":"Unicycler: Resolving bacterial genome assemblies from short and long sequencing reads","volume":"13","author":"Wick","year":"2017","journal-title":"PloS Comput. Biol."},{"key":"B25","doi-asserted-by":"publisher","first-page":"4492","DOI":"10.1128\/JB.00315-09","article-title":"Genome sequencing and comparative analysis of Klebsiella pneumoniae NTUH-K2044, a strain causing liver abscess and meningitis","volume":"191","author":"Wu","year":"2009","journal-title":"J. Bacteriol."},{"key":"B26","doi-asserted-by":"publisher","first-page":"e000102","DOI":"10.1099\/mgen.0.000102","article-title":"Identification of Klebsiella capsule synthesis loci from whole genome data","volume":"2","author":"Wyres","year":"2016","journal-title":"Microb. Genom."},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2021.641830","article-title":"A Sequence Type 23 Hypervirulent Klebsiella pneumoniae Strain Presenting Carbapenem Resistance by Acquiring an IncP1 bla(KPC-2) Plasmid","volume":"11","author":"Yan","year":"2021","journal-title":"Front. Cell Infect. Microbiol."},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2021.739461","article-title":"Co-conjugation of virulence plasmid and KPC plasmid in a clinical klebsiella pneumoniae strain","volume":"12","author":"Yang","year":"2021","journal-title":"Front. Microbiol."},{"key":"B29","doi-asserted-by":"publisher","first-page":"2640","DOI":"10.1093\/jac\/dks261","article-title":"Identification of acquired antimicrobial resistance genes","volume":"67","author":"Zankari","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"B30","doi-asserted-by":"publisher","first-page":"1602","DOI":"10.1038\/s42003-024-07310-2","article-title":"Two outbreak cases involving ST65-KL2 and ST11-KL64 hypervirulent carbapenem-resistant Klebsiella pneumoniae: similarity and diversity analysis","volume":"7","author":"Zhang","year":"2024","journal-title":"Commun. Biol."},{"key":"B31","doi-asserted-by":"publisher","first-page":"667","DOI":"10.1007\/s15010-024-02456-x","article-title":"The type VI secretion system as a potential predictor of subsequent bloodstream infection of carbapenem-resistant Klebsiella pneumoniae strains on intestinal colonization","volume":"53","author":"Zhao","year":"2025","journal-title":"Infection"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2021.691406","article-title":"The emergence of novel sequence type strains reveals an evolutionary process of intraspecies clone shifting in ICU-spreading carbapenem-resistant klebsiella pneumoniae","volume":"12","author":"Zhao","year":"2021","journal-title":"Front. Microbiol."},{"key":"B33","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.2025.1683743\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,19]],"date-time":"2025-12-19T06:27:06Z","timestamp":1766125626000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcimb.2025.1683743\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,19]]},"references-count":33,"alternative-id":["10.3389\/fcimb.2025.1683743"],"URL":"https:\/\/doi.org\/10.3389\/fcimb.2025.1683743","relation":{},"ISSN":["2235-2988"],"issn-type":[{"value":"2235-2988","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,19]]},"article-number":"1683743"}}