Emergence and molecular evolution of carbapenem-resistant hypervirulent ST23 Klebsiella pneumoniae: The superbug phenomenon in China

作者：Chen T, Wang X, Xiong L, Shen P, Xiao Y · 发表于：Virulence · 年份：2025 · DOI：10.1080/21505594.2025.2545556 · 被引用次数：64 · 研究领域：Klebsiella pneumoniae、Klebsiella Infections、Evolution, Molecular、Carbapenem-Resistant Enterobacteriaceae、Carbapenems、China、Humans、Phylogeny、Virulence、Bacterial Proteins、Molecular Epidemiology、beta-Lactamases

This study aimed to investigate the molecular epidemiology of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) ST23 in China. We conducted comprehensive searches across five databases (PubMed, Web of Science, MEDLINE, CNKI, and Wanfang) spanning 1980-2024, identifying 30 eligible studies through rigorous screening. Our synthesis documents 120 ST23 CR-hvKP clinical isolates, including the earliest known case from Zhejiang in 2013 which harbored blaKPC-2 alongside hallmark virulence loci (rmpA, rmpA2, iroN, iucA, and pagO). Epidemiological analysis of 119 isolates reveals geographic disparities: Hebei (25.2%) and Jiangxi (22.7%) are hotspots, while carbapenemase distribution exhibits a north-south divide (blaNDM predominating in northern China versus blaKPC in the south). Phylogenetic analysis of 584 global ST23 genomes suggests independent plasmid-mediated acquisition of carbapenemase genes, with evidence of clonal transmission both among humans and between humans and environmental niches. This review highlights the urgent need for surveillance to track CR-hvKP's evolving epidemiology, alongside interventions targeting plasmid-driven resistance spread.