Global emergence of Carbapenem-resistant Hypervirulent Klebsiella pneumoniae driven by an IncFII

Summary

Across thousands of genomes and multiple clinical isolate collections, an IncFII plasmid was identified as a key vehicle enabling convergence of carbapenem resistance and hypervirulence in K. pneumoniae, facilitating global dissemination of CR-hvKp.

Key Findings

• Integrated analysis of 67,631 genomes and multi-center clinical isolates implicated an IncFII plasmid in CR-hvKp emergence.
• IncFII-positive CR-hvKp genomes from 24 countries indicate global dissemination.
• Resistance (carbapenemase) acquisition on hvKp backgrounds underlies convergence of hypervirulence and carbapenem resistance.

Clinical Implications

Genomic surveillance should prioritize detection of IncFII plasmids in K. pneumoniae; infection control and stewardship policies can target plasmid-mediated spread and inform empiric therapy in high-risk settings.

Limitations

• Abstracted data indicate observational genomic associations without direct transmission or fitness experiments.
• Sampling bias in public databases may influence geographic and lineage representation.

Future Directions

Prospective genomic surveillance tracking IncFII plasmid movement, functional studies of transfer dynamics and fitness costs, and targeted infection control interventions in hotspots.