Loss of Hypermucoviscosity and Increased Fitness Cost in Colistin- Resistant Klebsiella pneumoniae Sequence Type 23 Strains

In this study, we investigated the effects of colistin resistance on virulence and fitness in hypermucoviscous (HV)Klebsiella pneumoniae sequence type 23 (ST23) strains. Colistin-resistant mutants were developed from three colistin-susceptible HVK. pneumoniae ST23 strains. The lipid A structures of strains were analyzed by matrix-assisted laser desorption ionization–time of flight (MALDI-TOF) mass spectrometry. Changes in HVwere investigated using the string test, and extracellular polysaccharide production was quantified. The expression levels of the phoQ, pmrD, pmrB, pbgP,magA, and p-rmpA2 genes, serum resistance, and biofilm-forming activity were determined. The fitness of colistin-resistant mutants compared to that of the parental strains was examined by determining the competitive index (CI). The colistin-resistant mutants exhibited reduced HV, which was ac-companied by decreased formation of capsular polysaccharides (CPS) and reduced expression of genes (magA and p-rmpA2). While there was enhanced expression of pmrD and pbgP in all colistin-resistant derivatives, there were differences in the expres-sion levels of phoQ and pmrB between strains. MALDI-TOF analysis detected the addition of aminoarabinose or palmitate to the lipid Amoiety of lipopolysaccharide in the colistin-resistant derivatives. In addition, survival rates in the presence of normal human serumwere decreased in the mutant strains, and CI values (0.01 to 0.19) indicated significant fitness defects in the colis-tin-resistant derivatives compared to the respective parental strains. In hypervirulent HV K. pneumoniae strains, the acquisition of colistin resistance was accompanied by reduced CPS production, impaired virulence, and a significant fitness cost. Highly invasive strains of Klebsiella pneumoniae that exhibit thehypermucoviscosity/hypermucoviscous (HV) phenotype have been reported as human pathogens, causing liver abscesses in pa