Kpi, a chaperone-usher pili system associated with the worldwide-disseminated high-risk clone

Significance Emergence of the pathogen Klebsiella pneumoniae (particularly of carbapenem-resistant strains) is considered a dire threat to public health. Resistance and virulence determinants may favor the emergence of untreatable infections. Understanding the mechanisms involved in the pathogenesis and epidemicity of K. pneumoniae is essential for managing outbreaks and developing treatments. Here we identify a CUP system (Kpi) and infer the epidemiology of Kpi+ K. pneumoniae in Europe. We demonstrate a direct link between Kpi presence and K. pneumoniae persistence in the hospital environment. Adherence of the bacterium to different cell types enables host colonization, favoring nosocomial outbreaks and spread of infection. Kpi appears to play a key role in the host–pathogen interaction and is associated with the worldwide-disseminated ST-15 clone.
Control of infections caused by carbapenem-resistant Klebsiella pneumoniae continues to be challenging. The success of this pathogen is favored by its ability to acquire antimicrobial resistance and to spread and persist in both the environment and in humans. The emergence of clinically important clones, such as sequence types 11, 15, 101, and 258, has been reported worldwide. However, the mechanisms promoting the dissemination of such high-risk clones are unknown. Unraveling the factors that play a role in the pathobiology and epidemicity of K. pneumoniae is therefore important for managing infections. To address this issue, we studied a carbapenem-resistant ST-15 K. pneumoniae isolate (Kp3380) that displayed a remarkable adherent phenotype with abundant pilus-like structures. Genome sequencing enabled us to identify a chaperone-usher pili system (Kpi) in Kp3380. Analysis of a large K. pneumoniae population from 32 European countries showed that the Kpi system is associated with the ST-15 clone. Phylogenetic analysis of the operon revealed that Kpi belongs to the little-characterized γ2-fimbrial clade. We demonstrate that Kpi contributes positively to the ability of K. pneumoniae to form biofilms and adhere to different host tissues. Moreover, the in vivo intestinal colonizing capacity of the Kpi-defective mutant was significantly reduced, as was its ability to infect Galleria mellonella. The findings provide information about the pathobiology and epidemicity of Kpi+ K. pneumoniae and indicate that the presence of Kpi may explain the success of the ST-15 clone. Disrupting bacterial adherence to the intestinal surface could potentially target gastrointestinal colonization.