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Front Microbiol. 2019 Feb 12;10:211. doi: 10.3389/fmicb.2019.00211. eCollection 2019.

Characterization of Clinically Relevant Strains of Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Occurring in Environmental Sources in a Rural Area of China by Using Whole-Genome Sequencing.

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Department of Environment and Health, School of Public Health, Shandong University, Jinan, China.
Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden.
State Key Laboratory for Diagnosis and Treatment of Infectious Disease, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
Department of Animal Health and Antimicrobial Strategies, National Veterinary Institute, Uppsala, Sweden.
Department of Risk and Benefit Assessment, National Food Agency, Uppsala, Sweden.
Department of Public Health Sciences, Global Health-Health Systems and Policy, Medicines, Focusing Antibiotics, Karolinska Institutet, Stockholm, Sweden.


Klebsiella pneumoniae is a gram-negative, opportunistic pathogen, and a common cause of healthcare-associated infections such as pneumonia, septicemia, and urinary tract infection. The purpose of this study was to survey the occurrence of and characterize K. pneumoniae in different environmental sources in a rural area of Shandong province, China. Two hundred and thirty-one samples from different environmental sources in 12 villages were screened for extended-spectrum β-lactamase-(ESBL)-producing K. pneumoniae, and 14 (6%) samples were positive. All isolates were multidrug-resistant and a few of them belonged to clinically relevant strains which are known to cause hospital outbreaks worldwide. Serotypes, virulence genes, serum survival, and phagocytosis survival were analyzed and the results showed the presence of virulence factors associated with highly virulent clones and a high degree of phagocytosis survivability, indicating the potential virulence of these isolates. These results emphasize the need for further studies designed to elucidate the role of the environment in transmission and dissemination of ESBL-producing K. pneumoniae and the potential risk posed to human and environmental health.


Klebsiella pneumoniae; environment; extended-spectrum β-lactamase; feces; multilocus sequence typing; pulsed-field gel electrophoresis; water; whole-genome sequencing

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