ABSTRACT Background Klebsiella pneumoniae is an important opportunistic pathogen and zoonotic pathogen. The widespread use of antibiotics has led to the emergence of a large number of multidrug-resistant Klebsiella pneumoniae in clinical animal husbandry, posing a serious threat to global health security. Protocatechuic acid (PCA) is a phenolic acid substance naturally present in many vegetables and fruits. It is a safe and highly developed new type of antibacterial synergist. Purpose This study explored the antibacterial and synergistic mechanisms of PCA against Carbapenem-resistant hypervirulent Klebsiella pneumoniae. Study design Metabolomic analysis using PCA to investigate the metabolic effects of CR-hvKP and further explore the antibacterial mechanisms resulting from this metabolic regulation. Methods The MIC of PCA was measured by microdilution, and its bactericidal effect was observed by DAPI staining. Resistance and hemolysis tests were performed to ensure safety. The synergy of PCA and meropenem was tested by checkerboard assay. The biofilm inhibition was assessed by crystal violet and EPS assays. The membrane morphology, permeability, and potential were examined by SEM, PI, NPN, and DiSC3(5). The metabolic changes were evaluated by AlamarBlue, metabolomics, enzyme activity, ELISA, molecular docking, and qRT-PCR. The oxidative stress and metabolic disorders were verified by NADP(H), ROS, MDA, and ATP assays. Results The results showed that PCA can synergize with antibiotics and inhibit the biofilm and membrane functions of CR-hvKP at low concentrations. Metabolomics revealed that PCA affects the EMP and PPP pathways of CR-hvKP, causing oxidative stress. This involves the binding of PGAM and the downregulation of BPGM, leading to the accumulation of glycerate-3P. This results in the inhibition of G6PDH and the imbalance of NADPH/NADP+, disrupting the energy metabolism and increasing the oxidative stress, which impair the biofilm and membrane functions and enhance the antibiotic efficacy. Conclusion The results demonstrate that PCA regulates the EMP-linked PPP pathway of CR-hvKP, inhibits biofilm and membrane functions, and synergizes with antibiotics to kill bacteria, providing new insights and candidates for natural antibacterial enhancers. Author Summary Klebsiella pneumoniae is a common pathogenic bacterium that can infect both humans and animals, causing serious diseases such as pneumonia, meningitis, and sepsis. Due to the overuse of antibiotics, this bacterium has developed resistance to many drugs, posing a significant threat to global health security. Through our research, we have discovered a natural substance called protocatechuic acid (PCA) that can enhance the effectiveness of antibiotics against this bacterium. PCA is found in many vegetables and fruits and is a safe and non-toxic antibacterial adjuvant. Our analysis of the metabolomics of PCA on Klebsiella pneumoniae has revealed its antibacterial and synergistic mechanisms. The study found that PCA can affect the bacterium’s sugar metabolism pathway, leading to the generation of endogenous oxidative stress. This disrupts their energy metabolism, damages their cell membranes and biofilms, making them more susceptible to being killed by antibiotics. Through this mechanism, PCA can synergize with common antibiotics such as meropenem, enhancing their bactericidal ability. Our research has demonstrated that PCA is an effective antibacterial adjuvant, providing new candidates and insights for the development of natural antibacterial agents. Graphical abstract

Protocatechuic acid induces endogenous oxidative stress in CR-hvKP by regulating the EMP-PPP pathway