---
title: "pLVPK plasmid stability drives global spread of carbapenem-resistant hypervirulent Klebsiella pneu"
id: "pubmed-42687087"
canonical_url: "https://medichelpline.com/clinical-feed/pubmed-42687087"
content_type: "clinical_feed_article"
specialty: "Critical Care"
source_name: "PubMed / NCBI"
source_url: "https://pubmed.ncbi.nlm.nih.gov/42687087/"
doi: "10.1007/s10123-026-00888-z"
published_at: "2026-09-03T00:00:00.000Z"
evidence_level: "Journal Article"
license: "CC-BY-NC-4.0 / Informational Use"
---
# pLVPK plasmid stability drives global spread of carbapenem-resistant hypervirulent Klebsiella pneu
## Provenance & Clinical Metadata
- **Canonical URL:** https://medichelpline.com/clinical-feed/pubmed-42687087
- **Specialty:** [Critical Care](https://medichelpline.com/clinical-feed/critical-care.md)
- **Primary Source:** PubMed / NCBI
- **Source URL:** [Original Journal Publication](https://pubmed.ncbi.nlm.nih.gov/42687087/)
- **DOI:** [10.1007/s10123-026-00888-z](https://doi.org/10.1007%2Fs10123-026-00888-z)
- **Published At:** 2026-09-03T00:00:00.000Z
- **Evidence Rating:** Journal Article
## Executive GIST (TL;DR)
- The study analyzed 43,722 Klebsiella pneumoniae genomes from 112 countries (2011–2022) to investigate why the ST11-KL64 subclone has become epidemiologically dominant among carbapenem-resistant strains. - Comparative genomic methods (Kleborate, RAST, PlasmidFinder, hybrid assemblies) assessed capsular type (KL64 vs KL47), virulence gene carriage (including **aerobactin** and RmpADC), plasmid stability, and plasmid-chromosome interactions. - ST11-KL64 expanded rapidly after 2016 and surpassed KL47 as China’s leading CRKP subtype (40.5% vs 28.9%), with notable regional predominance in Zhejiang (62.3%) and Sichuan (58.7%). - Most KL64 isolates (94.8%) retained intact **pLVPK**-like virulence plasmids; KL64 showed higher aerobactin carriage (60.5%) compared with KL47 (27.3%). - KL47 more frequently underwent plasmid fusion (58.8% with IncFIB[pNDM-Mar]) or chromosomal integration (41.4%), reducing virulence gene retention. - Quantitatively, KL64 demonstrated superior plasmid stability (71.2% gene retention) versus KL47 (43.6% gene retention). - Clinical correlation found KL64 associated with more severe outcomes (OR = 2.34, 95% CI 1.67–3.28). - The authors conclude that stable maintenance of **pLVPK** plasmids enables co-presence of carbapenem resistance and hypervirulence in ST11-KL64, underlining the need for genomic surveillance focused on plasmid-mediated virulence in CRKP outbreaks, especially in critical care settings.
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Online ahead of print. # A fitness advantage from the pLVPK plasmid fuels the global spread of a carbapenem-resistant hypervirulent Klebsiella pneumoniae high-risk clone: ST11-KL64 [Yalu Ren](https://pubmed.ncbi.nlm.nih.gov/?term=Ren+Y&cauthor_id=42687087)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#full-view-affiliation-1 "Center of Clinical Laboratory, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, People's Republic of China."), [Xiaoping Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+X&cauthor_id=42687087)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#full-view-affiliation-1 "Center of Clinical Laboratory, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, People's Republic of China."), [Li Ju](https://pubmed.ncbi.nlm.nih.gov/?term=Ju+L&cauthor_id=42687087)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#full-view-affiliation-1 "Center of Clinical Laboratory, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, People's Republic of China."), [Yanping Yao](https://pubmed.ncbi.nlm.nih.gov/?term=Yao+Y&cauthor_id=42687087)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#full-view-affiliation-2 "Department of Pharmacy, Suzhou Xiangcheng People's Hospital, Suzhou, Jiangsu, People's Republic of China."), [Xu Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+X&cauthor_id=42687087)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#full-view-affiliation-1 "Center of Clinical Laboratory, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, People's Republic of China."), [Xi Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+X&cauthor_id=42687087)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#full-view-affiliation-3 "Department of Radiation Oncology, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, People's Republic of China. ci49802974@163.com.") Affiliations Expand ### Affiliations * 1 Center of Clinical Laboratory, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, People's Republic of China. * 2 Department of Pharmacy, Suzhou Xiangcheng People's Hospital, Suzhou, Jiangsu, People's Republic of China. * 3 Department of Radiation Oncology, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, People's Republic of China. ci49802974@163.com. * PMID: **42687087** * DOI: [ 10.1007/s10123-026-00888-z ](https://doi.org/10.1007/s10123-026-00888-z) Item in Clipboard # A fitness advantage from the pLVPK plasmid fuels the global spread of a carbapenem-resistant hypervirulent Klebsiella pneumoniae high-risk clone: ST11-KL64 Yalu Ren et al. Int Microbiol. 2026. Show details Display options Display options Format Abstract PubMed PMID Int Microbiol Actions * [ Search in PubMed ](https://pubmed.ncbi.nlm.nih.gov/?term=%22Int+Microbiol%22%5Bjour%5D&sort=date&sort_order=desc) * [ Search in NLM Catalog ](https://www.ncbi.nlm.nih.gov/nlmcatalog?term=%22Int+Microbiol%22%5BTitle+Abbreviation%5D) * [ Add to Search ](https://pubmed.ncbi.nlm.nih.gov/42687087/) . 2026 Sep 3. doi: 10.1007/s10123-026-00888-z. Online ahead of print. ### Authors [Yalu Ren](https://pubmed.ncbi.nlm.nih.gov/?term=Ren+Y&cauthor_id=42687087)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#short-view-affiliation-1 "Center of Clinical Laboratory, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, People's Republic of China."), [Xiaoping Li](https://pubmed.ncbi.nlm.nih.gov/?term=Li+X&cauthor_id=42687087)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#short-view-affiliation-1 "Center of Clinical Laboratory, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, People's Republic of China."), [Li Ju](https://pubmed.ncbi.nlm.nih.gov/?term=Ju+L&cauthor_id=42687087)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#short-view-affiliation-1 "Center of Clinical Laboratory, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, People's Republic of China."), [Yanping Yao](https://pubmed.ncbi.nlm.nih.gov/?term=Yao+Y&cauthor_id=42687087)[ 2 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#short-view-affiliation-2 "Department of Pharmacy, Suzhou Xiangcheng People's Hospital, Suzhou, Jiangsu, People's Republic of China."), [Xu Chen](https://pubmed.ncbi.nlm.nih.gov/?term=Chen+X&cauthor_id=42687087)[ 1 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#short-view-affiliation-1 "Center of Clinical Laboratory, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, People's Republic of China."), [Xi Wang](https://pubmed.ncbi.nlm.nih.gov/?term=Wang+X&cauthor_id=42687087)[ 3 ](https://pubmed.ncbi.nlm.nih.gov/42687087/#short-view-affiliation-3 "Department of Radiation Oncology, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, People's Republic of China. ci49802974@163.com.") ### Affiliations * 1 Center of Clinical Laboratory, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, People's Republic of China. * 2 Department of Pharmacy, Suzhou Xiangcheng People's Hospital, Suzhou, Jiangsu, People's Republic of China. * 3 Department of Radiation Oncology, First Affiliated Hospital of Soochow University, 899 Pinghai Road, Suzhou, 215006, Jiangsu, People's Republic of China. ci49802974@163.com. * PMID: **42687087** * DOI: [ 10.1007/s10123-026-00888-z ](https://doi.org/10.1007/s10123-026-00888-z) Item in Clipboard Cite Display options Display options Format Abstract PubMed PMID ## Abstract **Background:** The global emergence of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP), particularly the ST11-KL64 subclone acquiring pLVPK-like virulence plasmids, represents a critical public health threat. This study investigates the epidemiological dominance and molecular mechanisms underlying ST11-KL64's fitness advantage over KL47 variants. **Methods:** We performed comparative genomic analysis on 43,722 K. pneumoniae genomes (2011-2022) from 112 countries, focusing on ST11-CRKP strains. Capsular typing (KL64 vs. KL47), virulence gene profiling (aerobactin, RmpADC), and plasmid stability analysis were conducted using Kleborate, RAST, and PlasmidFinder. Plasmid-chromosome interactions were characterized through hybrid assembly approaches. **Results:** ST11-KL64 demonstrated rapid expansion post-2016, surpassing KL47 as China's dominant CRKP subtype (40.5% vs. 28.9%), with regional predominance in Zhejiang (62.3%) and Sichuan (58.7%) provinces. Notably, 94.8% of KL64 strains maintained intact pLVPK plasmids with high aerobactin carriage (60.5%), while KL47 exhibited frequent plasmid fusion (58.8% with IncFIB[pNDM-Mar]) or chromosomal integration (41.4%), resulting in lower virulence potential (27.3% aerobactin+). Genomic analysis revealed KL64's superior plasmid stability (71.2% gene retention vs. KL47's 43.6%) and clinical correlation with severe outcomes (OR = 2.34, 95%CI 1.67-3.28). **Conclusion:** The ST11-KL64 subclone's epidemiological success stems from stable pLVPK plasmid maintenance, enabling simultaneous carbapenem resistance and hypervirulence. These findings highlight the urgent need for genomic surveillance targeting plasmid-mediated virulence in CRKP outbreaks, particularly in critical care settings where horizontal gene transfer may accelerate strain evolution. **Keywords:** Klebsiella pneumonia; Aerobactin; KL47; KL64; pLVPK. © 2026. The Author(s). [PubMed Disclaimer](https://pubmed.ncbi.nlm.nih.gov/disclaimer/) ## Conflict of interest statement Declarations. Ethics approval and consent to participate: Not applicable. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests. ## References 1. 1. Wyres KL, Lam M, Holt KE (2020) Population genomics of Klebsiella pneumoniae. Nat Rev Microbiol 18(6):344–359 - [DOI](https://doi.org/10.1038/s41579-019-0315-1) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/32055025/) 2. 1. Gorrie CL, Mirčeta M, Wick RR, Edwards DJ, Thomson NR, Strugnell RA et al (2017) Gastrointestinal carriage is a major reservoir of Klebsiella pneumoniae infection in intensive care patients. Clin Infect Dis 65(2):208–215 - [DOI](https://doi.org/10.1093/cid/cix270) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/28369261/) - [PMC](https://pmc.ncbi.nlm.nih.gov/articles/5850561/) 3. 1. Jones RN (2010) Microbial etiologies of hospital-acquired bacterial pneumonia and ventilator-associated bacterial pneumonia. Clin Infect Dis 51(Supplement1):S81–S87 - [DOI](https://doi.org/10.1086/653053) - [PubMed](https://pubmed.ncbi.nlm.nih.gov/20597676/) 4. 1. Tang XJ, Sun B, Ding X, Li H, Feng X (2020) Changing trends in the bacteriological profiles and antibiotic susceptibility in neonatal sepsis at a tertiary children’s hospital of China. Translational Pediatr 9(6):734 - [DOI](https://doi.org/10.21037/tp-20-115) 5. 1. CDC (2019) Antibiotic Resistance Threats in the United States, 2019. 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