Abstract

Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) has been increasingly reported and is now recognized as a public health concern. The aim of this study was to investigate the molecular epidemiology of CR-hvKp strains that were isolated from an Iranian hospital. A total of 74 non-duplicated carbapenem-resistant K. pneumoniae (CR-Kp) were collected from patients' clinical or surveillance cultures. Resistance/virulence genes were identified by PCR and sequencing. String test, capsular genotyping, conjugation assays, PCR-based replicon typing, pulsed field gel electrophoresis (PFGE), multilocus sequence typing (MLST) and were performed. All 74 CR-Kp isolates were carbapenemase producers, which co-carried multiple resistance genes such as bla(CTX-M-15), bla(TEM-1), bla(SHV-type), qnrB1, and qnrS1. The most common carbapenemase gene was bla(OXA-48) (67/74 90.5), followed by bla(NDM-1) (18/74 24.3), and bla(NDM-7) (3/74 4). The bla(OXA-48) and bla(NDM-1) were found on IncL/M and IncFII conjugative plasmids, respectively. Of 74 CR-Kp isolates, 49 were positive for string test. Capsular genotyping revealed that 34 and 10 CR-Kp strains belonged to the K1 and K2 serotypes, respectively. rmpA was the most prevalent virulence gene detected in 64.8 of the isolates. Fifty two strains were identified as CR-hvKp. PFGE typing showed 5 different clusters with two major clusters B (39 isolates, 52.7) associated with sequence type 11 (ST11), and A (21 isolates, 28.4) associated with ST893. Furthermore, ST147, ST392, and ST15 carbapenemase producers have also been sporadically identified. One isolate belonging to ST11 was resistant to colistin and were negative for mcr-1-2-3 genes. Insertional inactivation of mgrB due to IS elements was observed in the colistin-resistant isolate. Our findings suggest that ST11 CR-hvKP strain has a clonal distribution in our hospital. Therefore, immediate implementation of infection-control measures may be the best way to prevent the spread of these clones.