Carbapenem-Resistant Klebsiella pneumoniae of Sequence Type 11: A Scoping Review

Abstract Carbapenem-resistant Klebsiella pneumoniae (CRKP) is classified by the World Health Organization as a top-priority pathogen due to its extensive prevalence and dissemination, antimicrobial resistance, and high mortality rates. ST11 CRKP is the most prevalent type in parts of Asia and South America. The success and dissemination of ST11 CRKP can be partly attributed to several key evolutionary events, including the acquisition of the KPC-2 plasmid plus altered outer membrane proteins OmpK35 and OmpK36 that confer carbapenem resistance, the subsequent capsule switching that led to the emergence of the KL64 capsule type, and the further acquisition of virulence plasmids commonly associated with the hypervirulent ST23 lineage. In this review, we summarize the current research advances of these key events, discuss existing knowledge gaps, and propose future directions to understand why ST11 CRKP has emerged as such a dominant and clinically significant clone.