Case Study and Genomic Analysis of a Hypervirulent ST25 Klebsiella pneumoniae Strain in a Liver Cirrhosis Patient

Yizhang Wang Department of Clinical Laboratory, Sanmen People’s Hospital, Sanmen, Zhejiang, People’s Republic of ChinaCorrespondence: Yizhang Wang, Department of Clinical Laboratory, Sanmen People’s Hospital, No. 15 Taihe Road, Hairun Street, Sanmen, 317100, People’s Republic of China, Tel/Fax +86-576-83307235, Email [email protected]: Bloodstream infections (BSIs) caused by Klebsiella pneumoniae (K. pneumoniae) are associated with high morbidity and mortality rates. This study presents a sequence type 25 (ST25) strain of hypermucoid K. pneumoniae A1 isolated from the blood of a patient with liver cirrhosis (LC) who succumbed to severe infections. We performed whole-genome sequencing of K. pneumoniae A1, which revealed virulence factors and antibiotic resistance genes. The strain harbors virulence genes encoding aerobactin, salmochelin, yersiniabactin, enterobactin, and rmpA. Additionally, the strain possessed five drug resistance genes: blaSHV-110, blaSHV-81, fosA6, OqxA, and OqxB. We further constructed a phylogenetic tree using 98 ST25 K. pneumoniae strains downloaded from NCBI together with K. pneumoniae A1. Phylogenetic analysis revealed that our isolated strain was closely related to a highly virulent strain isolated from a neonate in our region, differing by only 123 single nucleotide polymorphisms (SNPs). K. pneumoniae A1 is highly suspected to be Hypervirulent Klebsiella pneumoniae (hvKp). This study provided the first in-depth genomic analysis of ST25 K. pneumoniae in a patient with LC in China, highlighting the urgent need for early identification and diagnosis to combat this emerging threat.Keywords: sequence type 25, Klebsiella pneumoniae, hypervirulent, bloodstream infections, liver cirrhosis