# Detection of Hypervirulence Genes and Drug Resistance in Klebsiella pneumoniae in Diagnostic Microbiology

## TL;DR

This study identifies hypervirulent Klebsiella pneumoniae (hvKp) and its drug resistance in patients, highlighting the need for accurate diagnosis to improve outcomes.

## Contribution

The study provides insights into the clinical and molecular characteristics of hvKp and its impact on patient outcomes.

## Key findings

- 17 out of 300 isolates possessed hypervirulence genes, with hvKp showing higher rates of pyogenic liver abscess and multiple infection sites.
- Carbapenem resistance and multidrug resistance were observed in 35.29% of hvKp strains, with a mortality rate of 23.52%.
- The combination of genetic markers rmpA and iucA showed high diagnostic accuracy for hvKp.

## Abstract

Objective: Hypervirulent Klebsiella pneumoniae (hvKp) is emerging and gaining notoriety due to the acquisition of drug resistance. Differentiation of hvKp from classical Klebsiella pneumoniae (cKp) is essential for prompt initiation of therapy to prevent metastasis, detection of occult abscesses, and site-specific management for better patient outcomes.

Methods: A total of 300 K. pneumoniae isolates from various clinical specimens were collected from 256 patients to determine their clinical profiles, antibiograms, risk factors, and patient outcomes. Hypermucoviscosity was demonstrated via a phenotypic string test. The hvKp pathotype was classified by molecular detection of the virulence genes rmpA and/or aerobactin-iucA.

Results:
K. pneumoniae infections affected the older age group (> 50 years) of both sexes, with a male preponderance (62.89%). Urinary tract infections were the most common clinical presentation (37.33%). Among the 300 isolates, 17 (5.66%) possessed hypervirulence genes, and 281 (93.66%) isolates were string test positive. Pyogenic liver abscess was more frequently observed in hvKp infections (5.88%) than in cKp infections (1.76%). Multiple sites were involved in 35.29% of the hvKp infections. (p < 0.05). Hypertension was the common comorbidity observed in the majority of the 256 patients (61.32%). The ICU stay (64.70%) predisposed patients to hvKp infections (p < 0.05). Compared with hvKp, cKp presented high rates of resistance to antibiotics. Although extended-spectrum beta-lactamase (ESBL) producers were significantly more common in cKp, 41.1% of hvKp strains were ESBLs. Carbapenem resistance and multidrug resistance were observed in 35.29% of the hvKp strains. The mortality rate in patients infected with hvKp was 23.52%.

Conclusion: The potential for occult abscess and metastasis with life-threatening complications necessitates prompt, accurate identification of hvKp. Convergence of hvKp and cKp with shared traits poses a diagnostic and therapeutic dilemma for clinicians. The combination of genetic markers such as rmpA with iucA has high reported diagnostic accuracy. Further studies are needed to better characterize hvKp in the clinical laboratory.