Virulence Factors and Carbapenem-Resistance Mechanisms in Hypervirulent Klebsiella Pneumoniae

References

• Choby JE, Howard-Anderson J, Weiss DS. Hypervirulent Klebsiella pneumoniae-clinical and molecular perspectives. J Intern Med. 2020;287(3):283–300. doi:10.1111/joim.13007
   PubMed Web of Science ®Google Scholar
• Liu YC, Cheng DL, Lin CL. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med. 1986;146(10):1913–1916.
   PubMedGoogle Scholar
• Russo TA, Marr CM. Hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev. 2019;32(3):e00001–19. doi:10.1128/CMR.00001-19
   PubMed Web of Science ®Google Scholar
• Tan TY, Ong M, Cheng Y, et al. Hypermucoviscosity, rmpA, and aerobactin are associated with community-acquired Klebsiella pneumoniae bacteremic isolates causing liver abscess in Singapore. J Microbiol Immunol Infect. 2019;52(1):30–34. doi:10.1016/j.jmii.2017.07.003
   PubMedGoogle Scholar
• Huang Y, Cai Y, He W, et al. Clinical and molecular epidemiological characteristics of hypervirulent and carbapenem-resistant Klebsiella pneumoniae causing blood stream infection. Chin J Nosocomiol. 2023;33(22):3417–3422.
   Google Scholar
• Qiao Y, Sun H, Li J, et al. Clinical and molecular characteristics of carbapenem-resistant hypervirulent Klebsiella pneumoniae in a teaching hospital. Chin J Infect Control. 2022;21(12):1185–1192.
   Google Scholar
• Lee CH, Liu JW, Su LH, et al. Hypermucoviscosity associated with Klebsiella pneumoniae-mediated invasive syndrome: a prospective cross-sectional study in Taiwan. Int J Infect Dis. 2010;14(8):e688–92.
   PubMed Web of Science ®Google Scholar
• Yu WL, Ko WC, Cheng KC, et al. Comparison of prevalence of virulence factors for Klebsiella pneumoniae liver abscesses between isolates with capsular K1 /K2 and non-K1 /K2 serotypes. Diagn Microbiol Infect Dis. 2008;62(1):1–6.
   PubMed Web of Science ®Google Scholar
• Lee HC, Chuang YC, Yu WL, et al. Clinical implications of hypermucoviscosity phenotype in Klebsiella pneumoniae isolates: association with invasive syndrome in patients with community-acquired bacteraemia. J Intern Med. 2006;259(6):606–614.
   PubMed Web of Science ®Google Scholar
• Harada S, Doi Y. Hypervirulent Klebsiella pneumoniae: a call for consensus definition and international collaboration. J Clin Microbiol. 2018;56(9):e00959–18.
   PubMed Web of Science ®Google Scholar
• Yu F, Lv J, Niu S, et al. Multiplex PCR analysis for rapid detection of Klebsiella pneumoniae carbapenem-resistant (Sequence Type 258[ST258]and ST11) and hypervirulent (ST23, ST65, ST86, and ST375) strains. J Clin Microbiol. 2018;56(9):e00731–18.
   PubMed Web of Science ®Google Scholar
• Russo TA, Olson R, Fang CT, et al. Identification of biomarkers for differentiation of hypervirulent Klebsiella pneumoniae from classical K.Pneumoniae. J Clin Microbiol. 2018;56(9):e00776–18.
   PubMed Web of Science ®Google Scholar
• Fan Q, Yang X, Hu R, et al. Application of PEG-344 gene encoding metabolite transporter in virulence identification of Klebsiella pneumoniae. Chin J Infect Control. 2022;21(5):414–419.
   Google Scholar
• Shon AS, Bajwa RP, Russo TA. Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed. Virulence. 2013;4(2):107–118. doi:10.4161/viru.22718
   PubMed Web of Science ®Google Scholar
• Han YL, Wen XH, Zhao W, et al. Epidemiological characteristics and molecular evolution mechanisms of carbapenem-resistant hypervirulent Klebsiella pneumoniae. Front Microbiol. 2022;13:1003783. doi:10.3389/fmicb.2022.1003783
   PubMed Web of Science ®Google Scholar
• Lan P, Jiang Y, Zhou J, et al. A global perspective on the convergence of hypervirulence and carbapenem resistance in Klebsiella pneumoniae. J Glob Antimicrob Resist. 2021;25:26–34. doi:10.1016/j.jgar.2021.02.020
   PubMed Web of Science ®Google Scholar
• Shon AS, Russo TA. Hypervirulent Klebsiella pneumoniae: the next superbug? Future Microbiol. 2012;7(6):669–671.
   PubMed Web of Science ®Google Scholar
• Lev AI, Astashkin EI, Kislichkina AA, et al. Comparative analysis of Klebsiella pneumoniae strains isolated in 2012–2016 that differ by antibiotic resistance genes and virulence genes profiles. Pathog Glob Health. 2018;112(3):142–151.
   PubMed Web of Science ®Google Scholar
• Zhang R, Dong N, Huang Y, et al. Evolution of tigecycline- and colistin-resistant CRKP (carbapenem-resistant Klebsiella pneumoniae) in vivo and its persistence in the GI tract. Emerg Microbes Infect. 2018;7(1):127. doi:10.1038/s41426-018-0129-7
   PubMed Web of Science ®Google Scholar
• Hu F, Guo Y, Zhu D, et al. Chinet surveillance of antimicrobial resistance among the bacterial isolates in 2021. Chin J Infect Chemother. 2022;22(5):521–530. doi:10.16718/j.1009-7708.2022.05.001
   Google Scholar
• Cejas D, Fernández Canigia L, Rincón Cruz G, et al. First isolate of KPC-2-producing Klebsiella pneumonaie sequence type 23 from the Americas. J Clin Microbiol. 2014;52(9):3483–3485. doi:10.1128/JCM.00726-14
   PubMed Web of Science ®Google Scholar
• Shankar C, Nabarro LE, Devanga Ragupathi NK, et al. Draft genome sequences of three hypervirulent carbapenem-resistant Klebsiella pneumoniae isolates from bacteremia. Genome Announc. 2016;4(6):e01081–16. doi:10.1128/genomeA.01081-16
   PubMedGoogle Scholar
• Arena F, Henrici De Angelis L, D’Andrea MM, et al. Infections caused by carbapenem-resistant Klebsiella pneumoniae with hypermucoviscous phenotype: a case report and literature review. Virulence. 2017;8(8):1900–1908. doi:10.1080/21505594.2017.1286439
   PubMed Web of Science ®Google Scholar
• Ahmed MAEE, Yang Y, Yang Y, et al. Emergence of Hypervirulent Carbapenem-Resistant Klebsiella pneumoniae Coharboring a blaNDM-1-Carrying Virulent Plasmid and a blaKPC-2-Carrying Plasmid in an Egyptian Hospital. mSphere. 2021;6(3):e00088–21. doi:10.1128/mSphere.00088-21
   PubMed Web of Science ®Google Scholar
• Yao B, Xiao X, Wang F, et al. Clinical and molecular characteristics of multi-clone carbapenem-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in a tertiary hospital in Beijing, China. Int J Infect Dis. 2015;37:107–112. doi:10.1016/j.ijid.2015.06.023
   PubMed Web of Science ®Google Scholar
• Zhou Y, Wang X, Shen J, et al. Endogenous Endophthalmitis Caused by Carbapenem-Resistant Hypervirulent Klebsiella Pneumoniae: a Case Report and Literature Review. Ocul Immunol Inflamm. 2019;27(7):1099–1104. doi:10.1080/09273948
   PubMed Web of Science ®Google Scholar
• Zhang Y, Jin L, Ouyang P, et al. Evolution of hypervirulence in carbapenem-resistant Klebsiella pneumoniae in China: a multicentre, molecular epidemiological analysis. J Antimicrob Chemother. 2020;75(2):327–336. doi:10.1093/jac/dkz446
   PubMed Web of Science ®Google Scholar
• Siu LK, Fung CP, Chang FY, et al. Molecular typing and virulence analysis of serotype K1 Klebsiella pneumoniae strains isolated from liver abscess patients and stool samples from noninfectious subjects in Hong Kong, Singapore, and Taiwan. J Clin Microbiol. 2011;49(11):3761–3765. doi:10.1128/JCM.00977-11
   PubMed Web of Science ®Google Scholar
• Chung DR, Lee SS, Lee HR, et al. Emerging invasive liver abscess caused by K1 serotype Klebsiella pneumoniae in Korea. J Infect. 2007;54(6):578–583. doi:10.1016/j.jinf.2006.11.008
   PubMed Web of Science ®Google Scholar
• Moore R, O’Shea D, Geoghegan T, et al. Community-acquired Klebsiella pneumoniae liver abscess: an emerging infection in Ireland and Europe. Infection. 2013;41(3):681–686. doi:10.1007/s15010-013-0408-0
   PubMed Web of Science ®Google Scholar
• Nadasy KA, Domiati-Saad R, Tribble MA. Invasive Klebsiella pneumoniae syndrome in North America. Clin Infect Dis. 2007;45(3):e25–8. doi:10.1086/519424
   PubMed Web of Science ®Google Scholar
• Zhang Y, Zhao C, Wang Q, et al. High Prevalence of Hypervirulent Klebsiella pneumoniae Infection in China: geographic Distribution, Clinical Characteristics, and Antimicrobial Resistance. Antimicrob Agents Chemother. 2016;60(10):6115–6120. doi:10.1128/AAC.01127-16
   PubMed Web of Science ®Google Scholar
• Ye M, Tu J, Jiang J, et al. Clinical and Genomic Analysis of Liver Abscess-Causing Klebsiella pneumoniae Identifies New Liver Abscess-Associated Virulence Genes. Front Cell Infect Microbiol. 2016;6:165. doi:10.3389/fcimb.2016.00165
   PubMed Web of Science ®Google Scholar
• Bialek-Davenet S, Nicolas-Chanoine MH, Decré D, Brisse S. Microbiological and clinical characteristics of bacteraemia caused by the hypermucoviscosity phenotype of Klebsiella pneumoniae in Korea. Epidemiol Infect. 2013;141(1):188. doi:10.1017/S0950268812002051
   PubMed Web of Science ®Google Scholar
• Cubero M, Grau I, Tubau F, et al. Hypervirulent Klebsiella pneumoniae clones causing bacteraemia in adults in a teaching hospital in Barcelona, Spain (2007–2013). Clin Microbiol Infect. 2016;22(2):154–160. doi:10.1016/j.cmi.2015.09.025
   PubMed Web of Science ®Google Scholar
• Parrott AM, Shi J, Aaron J, et al. Detection of multiple hypervirulent Klebsiella pneumoniae strains in a New York City hospital through screening of virulence genes. Clin Microbiol Infect. 2021;27(4):583–589. doi:10.1016/j.cmi.2020.05.012
   PubMed Web of Science ®Google Scholar
• Yang Y, Yang Y, Ahmed MAEE, et al. Carriage of distinct blaKPC-2 and blaOXA-48 plasmids in a single ST11 hypervirulent Klebsiella pneumoniae isolate in Egypt. BMC Genomics. 2022;23(1):20. doi:10.1186/s12864-021-08214-9
   PubMed Web of Science ®Google Scholar
• Lam MMC, Wyres KL, Duchêne S, et al. Population genomics of hypervirulent Klebsiella pneumoniae clonal-group 23 reveals early emergence and rapid global dissemination. Nat Commun. 2018;9(1):2703. doi:10.1038/s41467-018-05114-7
   PubMed Web of Science ®Google Scholar
• Qu TT, Zhou JC, Jiang Y, et al. Clinical and microbiological characteristics of Klebsiella pneumoniae liver abscess in East China. BMC Infect Dis. 2015;15:161. doi:10.1186/s12879-015-0899-7
   PubMed Web of Science ®Google Scholar
• Sanikhani R, Moeinirad M, Shahcheraghi F, et al. Molecular epidemiology of hypervirulent Klebsiella pneumoniae: a systematic review and meta-analysis. Iran J Microbiol. 2021;13(3):257–265. doi:10.18502/ijm.v13i3.6384
   PubMed Web of Science ®Google Scholar
• Shi Q, Lan P, Huang D, et al. Diversity of virulence level phenotype of hypervirulent Klebsiella pneumoniae from different sequence type lineage. BMC Microbiol. 2018;18(1):94. doi:10.1186/s12866-018-1236-2
   PubMedGoogle Scholar
• Guo Y, Wang S, Zhan L, et al. Microbiological and Clinical Characteristics of Hypermucoviscous Klebsiella pneumoniae Isolates Associated with Invasive Infections in China. Front Cell Infect Microbiol. 2017;7(24). doi:10.3389/fcimb.2017.00024
   Google Scholar
• Gu D, Dong N, Zheng Z, et al. A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study. Lancet Infect Dis. 2018;18(1):37–46. doi:10.1016/S1473-3099(17)30489-9
   PubMed Web of Science ®Google Scholar
• Chen Y, Marimuthu K, Teo J, et al. Acquisition of Plasmid with Carbapenem-Resistance Gene blaKPC2 in Hypervirulent Klebsiella pneumoniae, Singapore. Emerg Infect Dis. 2020;26(3):549–559. doi:10.3201/eid2603.191230
   PubMed Web of Science ®Google Scholar
• Zhang R, Lin D, Chan EW, et al. Emergence of Carbapenem-Resistant Serotype K1 Hypervirulent Klebsiella pneumoniae Strains in China. Antimicrob Agents Chemother. 2015;60(1):709–711. doi:10.1128/AAC.02173-15
   PubMed Web of Science ®Google Scholar
• Zhan L, Wang S, Guo Y, et al. Outbreak by Hypermucoviscous Klebsiella pneumoniae ST11 Isolates with Carbapenem Resistance in a Tertiary Hospital in China. Front Cell Infect Microbiol. 2017;7:182. doi:10.3389/fcimb.2017.00182
   PubMed Web of Science ®Google Scholar
• Paczosa MK, Mecsas J. Klebsiella pneumoniae: going on the Offense with a Strong Defense. Microbiol Mol Biol Rev. 2016;80(3):629–661. doi:10.1128/MMBR.00078-15
   PubMed Web of Science ®Google Scholar
• Prokesch BC, TeKippe M, Kim J, et al. Primary osteomyelitis caused by hypervirulent Klebsiella pneumoniae. Lancet Infect Dis. 2016;16(9):e190–e195. doi:10.1016/S1473-3099(16)30021-4
   PubMedGoogle Scholar
• Kim YJ, Kim SI, Kim YR, et al. Virulence factors and clinical patterns of hypermucoviscous Klebsiella pneumoniae isolated from urine. Infect Dis. 2017;49(3):178–184. doi:10.1080/23744235.2016.1244611
   PubMed Web of Science ®Google Scholar
• Mataseje LF, Boyd DA, Mulvey MR, et al. Two Hypervirulent Klebsiella pneumoniae Isolates Producing a blaKPC-2 Carbapenemase from a Canadian Patient. Antimicrob Agents Chemother. 2019;63(7):e00517–19. doi:10.1128/AAC.00517-19
   PubMed Web of Science ®Google Scholar
• Turton JF, Payne Z, Coward A, et al. Virulence genes in isolates of Klebsiella pneumoniae from the UK during 2016, including among carbapenemase gene-positive hypervirulent K1-ST23 and ‘non-hypervirulent’ types ST147, ST15 and ST383. J Med Microbiol. 2018;67(1):118–128. doi:10.1099/jmm.0.000653
   PubMed Web of Science ®Google Scholar
• Li G, Shi J, Zhao Y, et al. Identification of hypervirulent Klebsiella pneumoniae isolates using the string test in combination with Galleria mellonella infectivity. Eur J Clin Microbiol Infect Dis. 2020;39(9):1673–1679. doi:10.1007/s10096-020-03890-z
   PubMed Web of Science ®Google Scholar
• Russo TA, Olson R, MacDonald U, et al. Aerobactin, but not yersiniabactin, salmochelin, or enterobactin, enables the growth/survival of hypervirulent (hypermucoviscous) Klebsiella pneumoniae ex vivo and in vivo. Infect Immun. 2015;83(8):3325–3333. doi:10.1128/IAI.00430-15
   PubMed Web of Science ®Google Scholar
• Russo TA, Olson R, Macdonald U, et al. Aerobactin mediates virulence and accounts for increased siderophore production under iron-limiting conditions by hypervirulent (hypermucoviscous) Klebsiella pneumoniae. Infect Immun. 2014;82(6):2356–2367. doi:10.1128/IAI.01667-13
   PubMed Web of Science ®Google Scholar
• Walker KA, Miner TA, Palacios M, et al. A Klebsiella pneumoniae Regulatory Mutant Has Reduced Capsule Expression but Retains Hypermucoviscosity. mBio. 2019;10(2):e00089–19. doi:10.1128/mBio.00089-19
   PubMed Web of Science ®Google Scholar
• Walker KA, Treat LP, Sepúlveda VE, et al. The Small Protein RmpD Drives Hypermucoviscosity in Klebsiella pneumoniae. mBio. 2020;11(5):e01750–20. doi:10.1128/mBio.01750-20
   PubMed Web of Science ®Google Scholar
• Nassif X, Fournier JM, Arondel J, et al. Mucoid phenotype of Klebsiella pneumoniae is a plasmid-encoded virulence factor. Infect Immun. 1989;57(2):546–552. doi:10.1128/iai.57.2.546-552.1989
   PubMed Web of Science ®Google Scholar
• Shankar C, Veeraraghavan B, Nabarro LEB, et al. Whole genome analysis of hypervirulent Klebsiella pneumoniae isolates from community and hospital acquired bloodstream infection. BMC Microbiol. 2018;18(1):6. doi:10.1186/s12866-017-1148-6
   PubMedGoogle Scholar
• Wang W, Tian D, Hu D, et al. Different regulatory mechanisms of the capsule in hypervirulent Klebsiella pneumonia: ”direct” wcaJ variation vs. ”indirect” rmpA regulation. Front Cell Infect Microbiol. 2023;13(1108818). doi:10.3389/fcimb.2023.1108818
   Google Scholar
• Song S, Zhao S, Wang W, et al. Characterization of ST11 and ST15 Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae from Patients with Ventilator-Associated Pneumonia. Infect Drug Resist. 2023;16:6017–6028. doi:10.2147/IDR.S426901
   PubMed Web of Science ®Google Scholar
• Altayb HN, Elbadawi HS, Baothman O, et al. Genomic Analysis of Multidrug-Resistant Hypervirulent (Hypermucoviscous) Klebsiella pneumoniae Strain Lacking the Hypermucoviscous Regulators (rmpA/rmpA2). Antibiotics. 2022;11(5):596. doi:10.3390/antibiotics11050596
   Google Scholar
• Yang X, Sun Q, Li J, et al. Molecular epidemiology of carbapenem-resistant hypervirulent Klebsiella pneumoniae in China. Emerg Microbes Infect. 2022;11(1):841–849. doi:10.1080/22221751.2022.2049458
   PubMed Web of Science ®Google Scholar
• Fang CT, Chuang YP, Shun CT, Chang SC, Wang JT. A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exp Med. 2004;199(5):697–705. doi:10.1084/jem.20030857
   PubMed Web of Science ®Google Scholar
• Fang CT, Lai SY, Yi WC, et al. The function of wzy_K1 (magA), the serotype K1 polymerase gene in Klebsiella pneumoniae cps gene cluster. J Infect Dis. 2010;201(8):1268–1269. doi:10.1086/652183
   PubMed Web of Science ®Google Scholar
• Struve C, Roe CC, Stegger M, et al. Mapping the Evolution of Hypervirulent Klebsiella pneumoniae. mBio. 2015;6(4):e00630. doi:10.1128/mBio.00630-15
   PubMed Web of Science ®Google Scholar
• Guo L, Wang L, Zhao Q, et al. Genomic analysis of KPC-2-producing Klebsiella pneumoniae ST11 isolates at the respiratory department of a tertiary care hospital in Beijing. China Front Microbiol. 2022;13:929826.
   PubMedGoogle Scholar
• Liu BT, Su WQ. Whole genome sequencing of NDM-1-producing serotype K1 ST23 hypervirulent Klebsiella pneumoniae in China. J Med Microbiol. 2019;68(6):866–873. doi:10.1099/jmm.0.000996
   PubMed Web of Science ®Google Scholar
• Karlsson M, Stanton RA, Ansari U, et al. Identification of a Carbapenemase-Producing Hypervirulent Klebsiella pneumoniae Isolate in the United States. Antimicrob Agents Chemother. 2019;63(7):e00519. doi:10.1128/AAC.00519-19
   PubMed Web of Science ®Google Scholar
• Dong N, Yang X, Zhang R, et al. Tracking microevolution events among ST11 carbapenemase-producing hypervirulent Klebsiella pneumoniae outbreak strains. Emerg Microbes Infect. 2018;7(1):146. doi:10.1038/s41426-018-0146-6
   PubMed Web of Science ®Google Scholar
• Siu LK, Huang DB, Chiang T. Plasmid transferability of KPC into a virulent K2 serotype Klebsiella pneumoniae. BMC Infect Dis. 2014;14:176. doi:10.1186/1471-2334-14-176
   PubMed Web of Science ®Google Scholar
• Liu Y, Long D, Xiang TX, et al. Whole genome assembly and functional portrait of hypervirulent extensively drug-resistant NDM-1 and KPC-2 co-producing Klebsiella pneumoniae of capsular serotype K2 and ST86. J Antimicrob Chemother. 2019;74(5):1233–1240. doi:10.1093/jac/dkz023
   PubMed Web of Science ®Google Scholar
• Roulston KJ, Bharucha T, Turton JF, et al. A case of NDM-carbapenemase-producing hypervirulent Klebsiella pneumoniae sequence type 23 from the UK. JMM Case Rep. 2018;5(9):e005130. doi:10.1099/jmmcr.0.005130
   PubMedGoogle Scholar
• Li G, Jia L, Wan L, et al. Acquisition of a novel conjugative multidrug-resistant hypervirulent plasmid leads to hypervirulence in clinical carbapenem-resistant Klebsiella pneumoniae strains. mLife. 2023;2(3):217–338.
   Google Scholar
• Liu Y, Liu PP, Wang LH, et al. Capsular Polysaccharide Types and Virulence-Related Traits of Epidemic KPC-Producing Klebsiella pneumoniae Isolates in a Chinese University Hospital. Microb Drug Resist. 2017;23(7):901–907. doi:10.1089/mdr.2016.0222
   PubMed Web of Science ®Google Scholar
• Dong N, Liu L, Zhang R, et al. An IncR Plasmid Harbored by a Hypervirulent Carbapenem-Resistant Klebsiella pneumoniae Strain Possesses Five Tandem Repeats of the blaKPC-2:NTEKPC-Id Fragment. Antimicrob Agents Chemother. 2019;63(3):e01775–18. doi:10.1128/AAC.01775-18
   PubMed Web of Science ®Google Scholar
• Shu L, Dong N, Lu J, et al. Emergence of OXA-232 Carbapenemase-Producing Klebsiella pneumoniae That Carries a pLVPK-Like Virulence Plasmid among Elderly Patients in China. Antimicrob Agents Chemother. 2019;63(3):e02246–18. doi:10.1128/AAC.02246-18
   PubMed Web of Science ®Google Scholar
• Liu X, Li D, Hu Y, et al. Molecular epidemiological characterization of hypervirulent carbapenem-resistant Klebsiella pneumoniae in a hospital in Henan Province from 2020 to 2022. Chin J Prev Med. 2023;57(8):1222–1230. doi:10.3760/cma.j.cn112150-20230320-00204
   Google Scholar
• Xu Y, Zhang J, Wang M, et al. Mobilization of the nonconjugative virulence plasmid from hypervirulent Klebsiella pneumoniae. Genome Med. 2021;13(1):119. doi:10.1186/s13073-021-00936-5
   PubMed Web of Science ®Google Scholar
• Xie M, Yang X, Xu Q, et al. Clinical evolution of ST11 carbapenem resistant and hypervirulent Klebsiella pneumoniae. Commun Biol. 2021;4(1):650. doi:10.1038/s42003-021-02148-4
   PubMed Web of Science ®Google Scholar
• Yang X, Xie M, Xu Q, et al. Transmission of pLVPK-like virulence plasmid in Klebsiella pneumoniae mediated by an Incl1 conjugative helper plasmid. iScience. 2022;25(6):104428. doi:10.1016/j.isci.2022.104428
   PubMed Web of Science ®Google Scholar
• Ramirez MS, Traglia GM, Lin DL, et al. Plasmid-Mediated Antibiotic Resistance and Virulence in Gram-negatives: the Klebsiella pneumoniae Paradigm. Microbiol Spectr. 2014;2(5):1–15. doi:10.1128/microbiolspec
   PubMedGoogle Scholar
• Dong N, Lin D, Zhang R, et al. Carriage of blaKPC-2 by a virulence plasmid in hypervirulent Klebsiella pneumoniae. J Antimicrob Chemother. 2018;73(12):3317–3321. doi:10.1093/jac/dky358
   PubMed Web of Science ®Google Scholar
• Huang YH, Chou SH, Liang SW, et al. Emergence of an XDR and carbapenemase-producing hypervirulent Klebsiella pneumoniae strain in Taiwan. J Antimicrob Chemother. 2018;73(8):2039–2046. doi:10.1093/jac/dky164
   PubMed Web of Science ®Google Scholar