{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T22:15:04Z","timestamp":1791756904362,"version":"4.3.4"},"reference-count":26,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,9,1]],"date-time":"2021-09-01T00:00:00Z","timestamp":1630454400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007129","name":"Natural Science Foundation of Shandong Province","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100007129","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:p>The emergence of carbapenem-resistant hypervirulent <jats:italic>K. pneumoniae<\/jats:italic> (CR-hvKP) strains has increased the threat posed by <jats:italic>K. pneumoniae<\/jats:italic>. Here, we described an outbreak of 32 CR-hvKP isolates from the emergency intensive care unit (EICU) of a teaching hospital in China. Thirty-two CRKp isolates were collected from six patients and their surrounding environment in EICU. Antimicrobial susceptibility testing was performed using VITEK 2 compact system, E-test or the broth microdilution method. All isolates were serotyped, antimicrobial resistance genes and virulence-associated genes were screened using PCR. Multilocus sequence typing (MLST) and pulse-field gel electrophoresis (PFGE) were employed to characterize the genetic relationships among the CPKP isolates. The virulence capability of 11 CRKp isolates from six patients was evaluated through <jats:italic>Galleria mellonella<\/jats:italic> larva infection assay. PFGE showed that all 32 isolates belonged to one cluster, and MLST revealed that belonged to ST11. All isolates exhibited high resistance to \u03b2-lactam antibiotics, quinolones, and aminoglycosides. They were susceptible to ceftazidime\/averbatan, tigecycline, and colistin. All 32 isolates harbored <jats:italic>bla<\/jats:italic><jats:sub>KPC\u22122<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>SHV\u221211<\/jats:sub>, <jats:italic>bla<\/jats:italic><jats:sub>TEM\u22121<\/jats:sub>, <jats:italic>rmtB<\/jats:italic>, and <jats:italic>qnrD<\/jats:italic>. The serotype of all 32 isolates was K57. All 32 isolates contained 6 virulence genes, namely, <jats:italic>fimH, iucB, mrkD, rmpA, uge<\/jats:italic>, and <jats:italic>wabG<\/jats:italic>. Infection assays demonstrated high mortality in the <jats:italic>Galleria mellonella<\/jats:italic> model. Following measures implemented by the hospital, the outbreak was controlled. The mortality rate was 50.0%. The epidemiology of CR-hvKP should be monitored closely to detect early indications of this emerging public health threat.<\/jats:p>","DOI":"10.3389\/fpubh.2021.724212","type":"journal-article","created":{"date-parts":[[2021,9,4]],"date-time":"2021-09-04T01:44:52Z","timestamp":1630719892000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":18,"title":["An Outbreak of Carbapenem-Resistant Klebsiella pneumoniae of K57 Capsular Serotype in an Emergency Intensive Care Unit of a Teaching Hospital in China"],"prefix":"10.3389","volume":"9","author":[{"given":"Chunhong","family":"Shao","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yan","family":"Jin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wei","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meijie","family":"Jiang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuping","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,9,1]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"E3574","DOI":"10.1073\/pnas.1501049112","article-title":"Genomic analysis of diversity, population structure, virulence, and antimicrobial resistance in Klebsiella pneumoniae, an urgent threat to public health","volume":"112","author":"Holt","year":"2015","journal-title":"Proc Natl Acad Sci USA."},{"key":"B2","doi-asserted-by":"publisher","first-page":"148ra116","DOI":"10.1126\/scitranslmed.3004129","article-title":"Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumoniae with whole-genome sequencing","volume":"4","author":"Snitkin","year":"2012","journal-title":"Sci Transl Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"5873","DOI":"10.1128\/AAC.01019-15","article-title":"Carbapenemase-producing Klebsiella pneumoniae, a key pathogen set for global nosocomial dominance","volume":"59","author":"Pitout","year":"2015","journal-title":"Antimicrob Agents Chemother."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e00001","DOI":"10.1128\/CMR.00001-19","article-title":"Hypervirulent Klebsiella pneumoniae","volume":"32","author":"Russo","year":"2019","journal-title":"Clin Microbiol Rev"},{"key":"B5","doi-asserted-by":"publisher","first-page":"483","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":"B6","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1111\/joim.13007","article-title":"Hypervirulent Klebsiella pneumoniae- clinical and molecular perspectives","volume":"287","author":"Choby","year":"2020","journal-title":"J Intern Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"107","DOI":"10.4161\/viru.22718","article-title":"Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed","volume":"4","author":"Shon","year":"2013","journal-title":"Virulence."},{"key":"B8","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3389\/fpubh.2019.00229","article-title":"An outbreak of carbapenem-resistant and hypervirulent Klebsiella pneumoniae in an intensive care unit of a major teaching hospital in Wenzhou, China","volume":"7","author":"Zhao","year":"2019","journal-title":"Front Public Health."},{"key":"B9","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":"B10","doi-asserted-by":"publisher","first-page":"182","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. 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