National Academy of Sciences, Proceedings of the National Academy of Sciences, 29(117), p. 17249-17259, 2020
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Significance Emergence of the pathogen Klebsiella pneumoniae (particularly of carbapenem-resistant strains) is considered a dire threat to public health. Resistance and virulence determinants may favor the emergence of untreatable infections. Understanding the mechanisms involved in the pathogenesis and epidemicity of K. pneumoniae is essential for managing outbreaks and developing treatments. Here we identify a CUP system (Kpi) and infer the epidemiology of Kpi + K. pneumoniae in Europe. We demonstrate a direct link between Kpi presence and K . pneumoniae persistence in the hospital environment. Adherence of the bacterium to different cell types enables host colonization, favoring nosocomial outbreaks and spread of infection. Kpi appears to play a key role in the host–pathogen interaction and is associated with the worldwide-disseminated ST-15 clone.