Frontiers in Microbiology (Jun 2020)

The Diversity of Lipopolysaccharide (O) and Capsular Polysaccharide (K) Antigens of Invasive Klebsiella pneumoniae in a Multi-Country Collection

  • Myeongjin Choi,
  • Myeongjin Choi,
  • Nicolas Hegerle,
  • Nicolas Hegerle,
  • Joseph Nkeze,
  • Joseph Nkeze,
  • Shaichi Sen,
  • Shaichi Sen,
  • Sanchita Jamindar,
  • Sanchita Jamindar,
  • Shamima Nasrin,
  • Shamima Nasrin,
  • Sunil Sen,
  • Sunil Sen,
  • Jasnehta Permala-Booth,
  • Jasnehta Permala-Booth,
  • James Sinclair,
  • James Sinclair,
  • Milagritos D. Tapia,
  • Milagritos D. Tapia,
  • J. Kristie Johnson,
  • Sylla Mamadou,
  • Joshua T. Thaden,
  • Vance G. Fowler,
  • Vance G. Fowler,
  • Ana Aguilar,
  • Enrique Terán,
  • Dominique Decre,
  • Florence Morel,
  • Karen Angeliki Krogfelt,
  • Annelie Brauner,
  • Efthymia Protonotariou,
  • Eirini Christaki,
  • Eirini Christaki,
  • Yuichiro Shindo,
  • Yi-Tsung Lin,
  • Yi-Tsung Lin,
  • Andrea L. Kwa,
  • Andrea L. Kwa,
  • Andrea L. Kwa,
  • Sadia Shakoor,
  • Ashika Singh-Moodley,
  • Olga Perovic,
  • Jan Jacobs,
  • Jan Jacobs,
  • Octavie Lunguya,
  • Raphael Simon,
  • Raphael Simon,
  • Alan S. Cross,
  • Alan S. Cross,
  • Sharon M. Tennant,
  • Sharon M. Tennant

DOI
https://doi.org/10.3389/fmicb.2020.01249
Journal volume & issue
Vol. 11

Abstract

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Klebsiella pneumoniae is a common cause of sepsis and is particularly associated with healthcare-associated infections. New strategies are needed to prevent or treat infections due to the emergence of multi-drug resistant K. pneumoniae. The goal of this study was to determine the diversity and distribution of O (lipopolysaccharide) and K (capsular polysaccharide) antigens on a large (>500) global collection of K. pneumoniae strains isolated from blood to inform vaccine development efforts. A total of 645 K. pneumoniae isolates were collected from the blood of patients in 13 countries during 2005–2017. Antibiotic susceptibility was determined using the Kirby-Bauer disk diffusion method. O antigen types including the presence of modified O galactan types were determined by PCR. K types were determined by multiplex PCR and wzi capsular typing. Sequence types of isolates were determined by multilocus sequence typing (MLST) targeting seven housekeeping genes. Among 591 isolates tested for antimicrobial resistance, we observed that 19.3% of isolates were non-susceptible to carbapenems and 62.1% of isolates were multidrug resistant (from as low as 16% in Sweden to 94% in Pakistan). Among 645 isolates, four serotypes, O1, O2, O3, and O5, accounted for 90.1% of K. pneumoniae strains. Serotype O1 was associated with multidrug resistance. Fifty percent of 199 tested O1 and O2 strains were gmlABC-positive, indicating the presence of the modified polysaccharide subunit D-galactan III. The most common K type was K2 by both multiplex PCR and wzi capsular typing. Of 39 strains tested by MLST, 36 strains were assigned to 26 known sequence types of which ST14, ST25, and ST258 were the most common. Given the limited number of O antigen types, diverse K antigen types and the high multidrug resistance, we believe that an O antigen-based vaccine would offer an excellent prophylactic strategy to prevent K. pneumoniae invasive infection.

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