Post-infection colonization by ST11-KL64 Carbapenem-resistant Klebsiella pneumoniae enables persistent colonization through adaptive mutation leading to recurrent infections

Published: 29 May 2026| Version 4 | DOI: 10.17632/g5kx8g2gvr.4
Contributor:
Jiao Xu

Description

In March 2021, a patient was hospitalized due to a tumor. Following the initial CRKP infection, the patient recovered after antibiotic treatment and was discharged. Subsequently, the patient was hospitalized twice for recurrent fever and symptoms. Across the three hospitalizations, a total of eight CRKP strains were isolated.All strains were sequenced using Illumina HiSeq and assembled using SOAPdenovo v.2.04.

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On March 4, 2021, a 77-year-old woman hospitalized with abdominal pain and distension was diagnosed with gallbladder cancer at the Department of Hepatobiliary Surgery, Wuxi Second People's Hospital. Subsequently, the patient underwent anti-tumor therapy. On March 23, 2021, the patient presented with symptoms of fever and diarrhea. The first CRKP strain, designated CRKP-F1, was isolated from fecal samples on March 25, 2021. Following cefoperazone-sulbactam treatment, the patient's infection symptoms improved. A second strain (CRKP-S2) was still detected in sputum on March 30, 2021. After receiving continuous cefoperazone-sulbactam treatment, the patient's condition stabilized and was discharged smoothly. On November 17, 2021, the patient was hospitalized again due to fever accompanied by dyspnea. On November 19, 2021, CRKP-B3 was detected in the blood culture. On December 6, 2021, the patient underwent a urine culture test owing to dysuria, and CRKP-U4 was identified. On December 17, 2021, the patient presented with new symptoms of cough, expectoration, and fever, and then, CRKP-F5 and CRKP-S6 were detected in feces and sputum samples, respectively. Following ceftazidime-avibactam therapy, the patient was discharged again. On March 2, 2022, the patient was admitted to the hospital for the third time with dysuria and fever symptoms. On March 8, 2022, the urine culture results revealed the presence of CRKP-U7. During tigecycline-polymyxin combination therapy, blood culture detected CRKP-B8 again in March 18, 2022. The patient was discharged following ceftazidime treatment .

Institutions

Categories

Adaptation, Microorganism, Klebsiella Infection, Bacterial Evolution

Funders

  • Shanghai cooperation organization partnership
    Grant ID: 2025E01003
  • Haidong foundation
    Grant ID: 2021-HDKJ-Y5
  • the Sichuan Province Science and Technology project
    Grant ID: 2025ZNSFSC0677 and 2022YFS0631
  • Science and Technology Strategic Cooperation Programs of Luzhou Municipal People's Government and Southwest Medical University
    Grant ID: 2024LZXNYDT003
  • the Science Foundation of Xinjiang Institute of Ecology and Geography, Chinese Academy of Sciences
    Grant ID: E5190101

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