Virulence factors and clinical patterns of multiple-clone hypermucoviscous KPC-2 producing K. pneumoniae

Abstract Carbapenemase-producing Klebsiella pneumoniae (CRKP) are increasingly reported worldwide being necessary the local epidemiological monitoring. Our aim was to characterize the hypermucoviscous CRKP isolates collected in our hospital during a 6 months period. Carriage of the carbapenemase genes ( bla KPC , bla NDM , bla VIM and bla OXA-48 ), extended spectrum β-lactamases ( bla SHV-2 , bla CTX-M ) and the virulence genes ( mag A, k2A, rmp A, wab G, uge , all S, ent B, ycf M, kpn , wca G, fim H, mrk D, iut A, iro N, hly and cnf -1) were determined by multiplex-PCR. Genetic relationship among the isolates was performed by PFGE and MLST. A total of 35 isolates were recovered, being the urinary and respiratory tract the most common infection sites (34.2%). The bla KPC-2 gene was present in all the isolates, coexisting with bla CTX-M-2 (45.7%), bla SHV-2 (28.6%), and bla CTX-M-2 / bla SHV-2 (14.3%). The capsular serotype K2 corresponded with 68.6% of the isolates. Virulence factors frequency were variable [adhesins (97.1%), siderophores (94.3%) and phagocytosis resistance ( wab G 48.5%, uge 80% and ycf M 57.1%)]. A total of 10 STs were identified although 40% of them clustered on ST25-CC65, and 17% to ST17. The incidence of KPC-2-producing K. pneumoniae reported by the hospital was 0.290 per 1000 admissions. In summary we described an epidemic scenario of multidrug resistant hypermucoviscous KPC-2 producing ST25 K. pneumoniae in our institution.