Detection of multiple extensively-drug resistant hypervirulent

Area of Science:

• Microbiology
• Epidemiology
• Genetics

Background:

• Hypervirulent Klebsiella pneumoniae (hvKP) is a more virulent pathotype than classical K. pneumoniae (cKP), causing severe, fatal illnesses.
• Limited data exists on Egyptian hvKP, particularly regarding multidrug-resistant (MDR) strains' molecular characteristics and clonal spread.

Purpose of the Study:

• To investigate the microbiological, genetic, and epidemiological features of hvKP causing ventilator-associated pneumonia (VAP).

Main Methods:

• Retrospective study of 59 K. pneumoniae VAP isolates from Assiut University Hospitals (Nov 2017-Jan 2019).
• Phenotypic resistance testing, genotypic analysis (capsular K1/K2, virulence genes c-rmpA, p-rmpA, iucA, kfu, iroB, iroN), and resistance gene detection (blaNDM-1, blaCTX-M-3-like, blaCTX-M-14-like).
• Clonal relatedness assessed using Pulsed Field Gel Electrophoresis (PFGE).

Main Results:

• HvKP constituted 89.8% of isolates, with ~95% exhibiting extensively drug-resistant (XDR) phenotypes.
• The iucA virulence gene was most prevalent (98.1%) in hvKP. Resistance genes blaCTX-M-3-like, blaNDM-1, and blaCTX-M-14-like were highly prevalent.
• PFGE revealed 15 pulsotypes, indicating clonal spread of hvKP, with identical strains found in different ICUs and at different times.

Conclusions:

• This study underscores the prevalence and clonal dissemination of XDR-hvKP strains in Egyptian hospitals.
• Increased physician awareness of hvKP-induced VAP risk is crucial.
• Further epidemiological studies are recommended to monitor and control hvKP spread.