Coexistence of carbapenem resistance and hypervirulence in clinical Klebsiella pneumoniae isolates: a molecular and phenotypic analysis

Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CRhvKp) is increasingly recognized as the predominant nosocomial pathogen in healthcare environments. This study aims to investigate the prevalence, antibiotic resistance patterns, and molecular characteristics of CRhvKp in Egypt. Out of 150 non-duplicate clinical isolates collected from a hospital in Egypt, 63 were identified as K. pneumoniae via biochemical tests and matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). The CRKp isolates were identified using the VITEK®2 system and KB disc diffusion. Subsequently, to define CRhvKp using PCR, a specific conjugation of rmpA and/or rmpA2 with iucA, iroB, or peg-344 was employed. Virulence and carbapenemase genes for CRKp isolates were screened via PCR, and the results of the carbapenemase genes were validated through Sanger sequencing. Among the 63 K. pneumoniae isolates, 30 were identified as CRKp, and all exhibited multidrug resistance (MDR). CRKp was classified as 66.7% for CRhvKp and 33.3% for CR-non-hvKp. The presence of various virulence genes in CRhvKp and CR-non-hvKp samples was observed as follows: fimH (75% and 60%), mrkD (100% and 90%), entB (80% and 90%), irp2 (85% and 90%), wabG (90% and 60%), and uge (40% and 60%). The existence of carbapenemase genes in CRhvKp and CR-non-hvKp samples was observed as follows: blaNDM (41.3% and 25.0%), blaKPC (10% and 5%), and blaOXA-48 (20.0% and 0.0%). Our study identified a significant percentage of MDR CRhvKp and CR-non-hvKp isolates harboring different carbapenemases, which sparked substantial concern. Herein, we highlight the concerning rapid increase of CRhvKp in Egypt. Hence, continued countrywide are surveillance is crucial to clarify the prevalence rate of these CRhvKp in Egypt.