Clinical and Molecular Profile of Klebsiella pneumoniae Bloodstream Infections in a National Referral Hospital in the Philippines

Objectives Klebsiella pneumoniae (Kp) bloodstream infections (BSIs) are a major concern in the Philippines, but both local clinical and molecular epidemiological data are limited. Study Design and Methodology We conducted a cross-sectional study at a government hospital in Manila from April 2023 to January 2024, analyzing clinical data with whole-genome sequencing of 39 cases. Results Most patients were male (mean age, 53 years) and had diabetes or malignancy. In-hospital mortality was 38.5%. ESBL and carbapenemase genes were identified in 41.0% and 33.3% of isolates, respectively, predominantly bla CTX-M-15 , bla NDM and bla KPC . The most frequent sequence type was ST437, followed by ST23, ST101, and ST17. Hypervirulence genes ( rmpA/A2, iuc, iro ) were detected in 25.6%, defining 10 hypervirulent Kp (hvKp) strains, including one carbapenem resistant-hvKp (CR-hvKp) strain carrying bla NDM-7 . Compared with classical Kp, hvKp infections resulted in higher rates of septic shock and infection-attributable mortality, despite lower multidrug resistance. Conclusion These findings underscore the high mortality risk from Kp BSIs, driven both by antimicrobial resistance and hypervirulence. Detection of both hvKp and CR-hvKp is a testament to the global spread of this critical priority pathogen.