Global spread and evolutionary convergence of multidrug-resistant and hypervirulent Klebsiella pneumoniae high-risk clones.

IF 4.9 4区 医学 Q1 PARASITOLOGY
Gabriele Arcari, Alessandra Carattoli
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引用次数: 10

Abstract

For people living in developed countries life span is growing at a faster pace than ever. One of the main reasons for such success is attributable to the introduction and extensive use in the clinical practice of antibiotics over the course of the last seven decades. In hospital settings, Klebsiella pneumoniae represents a well-known and commonly described opportunistic pathogen, typically characterized by resistance to several antibiotic classes. On the other hand, the broad wedge of population living in Low and/or Middle Income Countries is increasing rapidly, allowing the spread of several commensal bacteria which are transmitted via human contact. Community transmission has been the original milieu of K. pneumoniae isolates characterized by an outstanding virulence (hypervirulent). These two characteristics, also defined as "pathotypes", originally emerged as different pathways in the evolutionary history of K. pneumoniae. For a long time, the Sequence Type (ST), which is defined by the combination of alleles of the 7 housekeeping genes of the Multi-Locus Sequence Typing, has been a reliable marker of the pathotype: multidrug-resistant clones (e.g. ST258, ST147, ST101) in the Western world and hypervirulent clones (e.g. ST23, ST65, ST86) in the Eastern. Currently, the boundaries separating the two pathotypes are fading away due to several factors, and we are witnessing a worrisome convergence in certain high-risk clones. Here we review the evidence available on confluence of multidrug-resistance and hypervirulence in specific K. pneumoniae clones.

多药耐药和高致病性肺炎克雷伯菌高危克隆的全球传播和进化趋同。
对于生活在发达国家的人来说,寿命的增长速度比以往任何时候都要快。取得如此成功的主要原因之一是在过去七十年中抗生素在临床实践中的引入和广泛使用。在医院环境中,肺炎克雷伯菌是一种众所周知且常被描述的机会性病原体,其典型特征是对几种抗生素具有耐药性。另一方面,生活在低收入和/或中等收入国家的人口正在迅速增加,从而使几种通过人类接触传播的共生细菌得以传播。社区传播一直是肺炎克雷伯菌分离株的原始环境,其特点是具有突出的毒力(高毒力)。这两种特征,也被定义为“病型”,最初是作为肺炎克雷伯菌进化史上的不同途径出现的。长期以来,序列型(Sequence Type, ST)是由多位点序列分型的7个内务基因的等位基因组合所定义的,是一种可靠的病型标记:在西方世界是多耐药克隆(如ST258、ST147、ST101),在东方是高毒克隆(如ST23、ST65、ST86)。目前,由于一些因素,两种疾病的界限正在消失,我们正在目睹某些高风险克隆中令人担忧的趋同。在这里,我们回顾了在特异性肺炎克雷伯菌克隆中多药耐药和高毒力汇合的现有证据。
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来源期刊
Pathogens and Global Health
Pathogens and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-PARASITOLOGY
CiteScore
6.00
自引率
0.00%
发文量
60
审稿时长
6-12 weeks
期刊介绍: Pathogens and Global Health is a journal of infectious disease and public health that focuses on the translation of molecular, immunological, genomics and epidemiological knowledge into control measures for global health threat. The journal publishes original innovative research papers, reviews articles and interviews policy makers and opinion leaders on health subjects of international relevance. It provides a forum for scientific, ethical and political discussion of new innovative solutions for controlling and eradicating infectious diseases, with particular emphasis on those diseases affecting the poorest regions of the world.
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