Hypervirulence Markers Among Non-ST11 Strains of Carbapenem- and Multidrug-ResistantKlebsiella pneumoniaeIsolated From Patients With Bloodstream Infections

Multidrug-resistantKlebsiella pneumoniaeand hypervirulentK. pneumoniae(hvKP) have traditionally been considered two individual populations; however, strains displaying both phenotypes have emerged during the recent decade. Understanding the genotypic and phenotypic basis of the convergence could be of clinical importance. In this study, we aimed to evaluate the pathogenicity associated with different combinations of genotypes (i.e., sequence types, virulence factors, and capsular serotypes) and phenotypes (i.e., hypermucoviscosity and drug susceptibility) inK. pneumoniae.A total of 11K. pneumoniaeisolates causing bloodstream infections were included in the study, and they were assigned to seven STs (ST23, ST15, ST268, ST660, ST86, ST65, and ST1660) and carried various K-loci (KL1, KL2, KL16, KL20, and KL24). Hypermucoviscosity was observed for six isolates.bla(KPC-2)was detected in six carbapenem-resistant isolates, and the remaining ones were either multidrug-resistant or resistant to two types of antibiotics. Aerobactin- and yersiniabactin-encoding genes were detected in all isolates. AlthoughrmpA2was detected in all isolates, most contained frameshift mutations (82%). Genes encoding salmochelin, RmpA, and PEG344 were detected in seven isolates. Colibactin-encoding genes were carried by six isolates. Discrepancies among measured virulence inGalleria mellonellaand the serum-killing assay, and genotypes and phenotypes were detected. The results illustrate the complexity and difficulty with the current knowledge of hypervirulence to predict the phenotype by using genetic and phenotypic markers. Additionally, the emergence of carbapenem resistance in two isolates of KPC-2-producing hvKP of different sequence types emphasizes the urgency with which reliable clinical diagnostics for hvKP is needed. Funding Agencies|National Key Research and Development Program of China [2017YFC1200200]; Major Infectious Diseases such as AIDS and Viral Hepatitis Prevention and Control Technology Major Projects [2018ZX10712-001]; National Natural Science Foundation of ChinaNational Natural Science Foundation of China [81702045, 81361138021]; Swedish Research Council for Environment, Agricultural Sciences and Spatial Planning (Formas)Swedish Research Council Formas [2016-00640]; Swedish Foundation for International Cooperation in Research and Higher Education (STINT) [CH2016-6707]; Shenzhen Basic Research Projects [JCYJ20190807144409307]