Multidrug-Resistant Klebsiella pneumoniae Causing Severe Infections in the Neuro-ICU

The purpose of this study was the identification of genetic lineages and antimicrobial resistance (AMR) and virulence genes in Klebsiella pneumoniae isolates associated with severe infections in the neuro-ICU. Susceptibility to antimicrobials was determined using the Vitek-2 instrument. AMR and virulence genes, sequence types (STs), and capsular types were identified by PCR. Whole-genome sequencing was conducted on the Illumina MiSeq platform. It was shown that K. pneumoniae isolates of ST14(K2), ST23(K57), ST39(K23), ST76(K23), ST86(K2), ST218(K57), ST219(KL125/114), ST268(K20), and ST2674(K47) caused severe systemic infections, including ST14(K2), ST39(K23), and ST268(K20) that were associated with fatal incomes. Moreover, eight isolates of ST395(K2) and ST307(KL102/149/155) were associated with manifestations of vasculitis and microcirculation disorders. Another 12 K. pneumoniae isolates of ST395(K2,KL39), ST307(KL102/149/155), and ST147(K14/64) were collected from patients without severe systemic infections. Major isolates (n = 38) were XDR and MDR. Beta-lactamase genes were identified: bla(SHV) (n = 41), bla(CTX-M) (n = 28), bla(TEM) (n = 21), bla(OXA-48) (n = 21), bla(NDM) (n = 1), and bla(KPC) (n = 1). The prevalent virulence genes were wabG (n = 41), fimH (n = 41), allS (n = 41), and uge (n = 34), and rarer, detected only in the genomes of the isolates causing severe systemic infections-rmpA (n = 8), kfu (n = 6), iroN (n = 5), and iroD (n = 5) indicating high potential of the isolates for hypervirulence.