Phylogenetic Analysis ofKlebsiella pneumoniaefrom Hospitalized Children, Pakistan

Klebsiella pneumoniae shows increasing emergence of multidrug-resistant lineages, including strains resistant to all available antimicrobial drugs. We conducted whole-genome sequencing of 178 highly drug-resistant isolates from a tertiary hospital in Lahore, Pakistan. Phylogenetic analyses to place these isolates into global context demonstrate the expansion of multiple independent lineages, including K. quasipneumoniae. K lebsiella spp. are gram-negative bacteria that are wide- ly distributed in the environment, and K. pneumoniae is a common cause of infection in humans (1). Increasingly, K. pneumoniae is reported as a cause of invasive bloodborne infections, particularly in healthcare settings and in immunocompromised patients (2). Of concern is that infection-associated K. pneumoniae is often multidrug resistant (MDR) and can harbor resistance determinants against most, if not all, commonly used antimicrobial drugs, posing a major threat to public health. The World Health Organization recently highlighted finding new treatments against MDR Enterobacteriaceae (including Klebsiella) as priority 1 (critical) (http://www.who.int/mediacentre/news/ releases/2017/bacteria-antibiotics-needed/en/). K. pneumoniae is a major pathogen in economically developed settings, and multiple outbreaks in different countries have been reported. Less is known about its prevalence in economically challenged areas, including lower and middle income countries (LMIC). Reports are now appearing about Klebsiella-associated infections in Nepal (3) and in Indonesia, Laos, and Vietnam (1). Klebsiella can spread rapidly in hospital environments, and the