Emergence of Hypervirulent Ceftazidime/Avibactam-Resistant Klebsiella pneumoniae Isolates in a Chinese Tertiary Hospital

Dan Li,1,2,* Wenjian Liao,1,2,* Hai-hua Huang,3 Fang-ling Du,4 Dan-dan Wei,4 Yan-fang Mei,4 Dan Long,4 La-gen Wan,4 Yang Liu,4 Wei Zhang1 1Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang 330006, People’s Republic of China; 2The First Clinical Medical College of Nanchang University, Nanchang University, Nanchang 330006, People’s Republic of China; 3Department of Endocrinology and Metabolism, First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang 330006, People’s Republic of China; 4Department of Clinical Microbiology, First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang 330006, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yang LiuDepartment of Clinical Microbiology, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, People’s Republic of ChinaTel +86-13576091584Fax +86-0791-88692748Email ly13767160474@sina.comWei ZhangDepartment of Respiratory Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, People’s Republic of ChinaTel +86-13707089183Fax +86-0791-88692748Email zhangweiliuxin@163.comIntroduction: Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) is increasingly reported worldwide, but ceftazidime/avibactam (CAZ/AVI)-resistant hvKP isolates have rarely been observed. We attempted to characterize them in clinical CRKP isolates collected from a university hospital in China from March 2016 to March 2018.Methods: All isolates were analyzed by antimicrobial susceptibility testing, molecular detection of antibiotic resistance determinants, multilocus sequence typing (MLST), SDS-PAGE, and pulsed-field gel electrophoresis (PFGE). The pLVPK-related genetic loci (rmpA2, terW, iutA, and silS) were screened in all CAZ/AVI-resistant CRKP isolates for the pre