Molecular Characterization and Risk Factors of Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae Isolated from Chinese Tertiary Hospital

Background: Therefore, the objectives of this study were to investigate the prevalence of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) in Fujian Medical University Union Hospital, identify their genetic characters, characterize their resistance profiles, and identify risk factors for their infection to improve prevention and treatment strategies for CR-hvKp in the area.

Methods: Between January 2021 and January 2022, clinically identified carbapenem-resistant Klebsiella pneumoniae (CRKp) isolates were collected. A PCR assay was used to detect the K capsule type, virulence genes, carbapenemase genes, and membrane pore protein. ERIC-PCR was carried out for homology analysis. Antimicrobial susceptibility test was used to determine drug resistance. Logistic multivariate regression analysis was conducted to confirm the risk factors for CR-hvKp infection.

Results: In total, 239 CRKp isolates were obtained. The virulence genes with the highest detection rates were mrkD, iucA, and rmpA2. Of these isolates, 54 (22.59%) carried both iucA and rmpA2, thus classifying them as CR-hvKp. All CR-hvKp isolates carried bla _KPC. Furthermore, capsular serotypes K64 (94.44%) and K47 (3.70%) were detected. Resistance was observed against most common antibiotics, with the exception of complete sensitivity to ceftazidime-avibactam. ERIC-PCR indicated a potential clonal spread among CR-hvKp. Multivariate analysis found that changing beds was a risk factor for CR-hvKp infection.

Conclusion: Currently, the hospital predominantly carries K64 CR-hvKp that harbors the bla _KPC. Our study found that changing patient beds was an independent risk factor for CR-hvKp infection.