Multicenter Surveillance of Klebsiella pneumoniae: Resistance Shifts, CRKP Prevalence and Hypervirulent Evolution Trajectories in Hebei, China (2019-2023)

Objective: To describe the patient characteristics, resistance trends of Klebsiella pneumoniae (Kpn), and the prevalence of carbapenem-resistant Kpn (CRKP) in Hebei (2019– 2023), and to explore genetic characteristics of CRKP underlying resistance shifts. Methods: WHONET 5.6 was employed to analyze patient characteristics of Kpn infections, resistance variations and CRKP prevalence using data from all 59 tertiary hospitals participating in Hebei Provincial Antimicrobial Resistance Surveillance System (HBARSS), 2019– 2023. A total of 424 CRKP isolates from four hospitals across northern, central, and southern Hebei were subjected to antimicrobial susceptibility testing and whole-genome sequencing. Genomic analyses were performed using Kaptive, Kleborate, and PlasmidFinder. Results: Surveillance data showed that a total of 114,166 non-duplicate Kpn isolates were identified, including 16,681 CRKP. Kpn infections were more common in males (63.4%) and mainly occurred in elderly (54.1%) and ICU patients (20.2%). Resistance rates to most antimicrobials declined overall, except for minocycline, tigecycline and polymyxin B, which fluctuated. CRKP prevalence fell from 15.3% (2019) to 12.8% (2023), averaging 14.6%. Analysis of 424 clinical CRKP showed that bla KPC-2 ST11-KL64 was the predominant type in both CRKP and hypervirulent CRKP (hv-CRKP), accounting for 40.1% and 69.1%, respectively. Notably, hv-CRKP among CRKP rose from 36.5% (2019) to 69.8% (2023), averaging 55.0%. Within ST11 hv-CRKP, 84.8% of KL64 isolates carried the iucABCDiutA + rmpA + rmpA2 + virulence profile, and 97.6% harbored IncHI1B or IncHI1B(pNDM-MAR)/repB plasmids. In contrast, 92.3% of KL47 isolates carried iucABCDiutA + rmpA − rmpA2 +, and 89.7% lacked IncHI1B or IncHI1B(pNDM-MAR)/repB. Furthermore, the proportion of ST11-KL64 hv-CRKP among ST11 CRKP increased from 38.7% in 2019 to 49.2% in 2023, while that of ST11-KL47 rose from 0% to 20.0%. Conclusion: Males, the elderly and ICU patients are susceptible populations. Despite declining resistance rate and CRKP prevalence in Hebei Province, China, hv-CRKP increased rapidly. And ST11-KL64 hv-CRKP and ST11-KL47 hv-CRKP showed different evolutionary patterns, with KL47 increasing more prominently.