Klebsiella pneumoniae is a public health concern because of its ability to develop multidrug resistance and hypervirulent genotypes, of those capsular types K1 and K2 cause community and nosocomial life-threatening infections. This study aimed to determine the antibiotic susceptibility patterns and genotypic traits of a collection of Klebsiella spp. isolates. Furthermore, the clonal relatedness of blaNDM producing strains was investigated. During a 19-months surveillance study, 122 Klebsiella spp. isolates were cultured from extraintestinal specimens of patients admitted to the tertiary referral hospital in Semnan, Iran. Isolates were identified using biochemical tests and subjected to determination of phylogroups, capsular types and virulence/resistance genes content. Hypervirulent K. pneumoniae (hvKp) strains were detected genotypically, and Enterobacterial Repetitive Intergenic Consensus (ERIC)-PCR fingerprinting was used to determine the clonality of blaNDM producing strains. Multidrug resistant phenotype was detected in 75 (61.5%) isolates and amikacin was found as the most potent antibiotic with the susceptibility rate of 85.2%. The carbapenemase genes were detected in 45 (36.8%) strains, including 21 (17.2%) blaOXA-48, 7 (5.6%) blaNDM-1, 14 (11.4%) blaNDM-1/OXA-48 and 3 (2.4%) blaIMP- carrying strains, while 55 (45.08%) isolates showed carbapenem resistant phenotype. The first blaNDM-1 carrying strain was cultured from a sputum specimen on March 2015, while the last positive one was recovered from blood culture on September 2016. Most of the isolates (80.3%) belonged to phylogroup I, and blaNDM-1 was identified among all three phylogroups. The ERIC-PCR clustered the 101 blaNDM negative and 21 blaNDM-1 positive isolates into 25 and five clusters, respectively, and the latter group belonged to clonal complex 147 (CC147). One K1 and 15 K2 blaNDM-1 negative isolates were detected, of those three strains were identified as hvKp. Five K2 positive strains, including four blaOXA-48 producer and one hvKp sequence type 86 (ST86) were carbapenem resistant. Among carbapenem resistant isolates, CC147 strains harboured higher rates of siderophores iutA and ybtS. The present findings showed a hospital circulation of CC147 blaNDM-1 or blaNDM-1/OXA-48 producing strains, disseminated in different wards. The hvKp/ST86 strain expressing K2 capsular type and carbapenem resistant phenotype wasn’t reported from Iran so far. So, it seems that we must be aware of the emergence and spread of new K. pneumoniae clones associated with resistant and hypermucoviscous phenotypes.

中文翻译：

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伊朗三级护理中心中带有bla _{NDM / OXA-48}碳青霉烯酶的循环克隆复合体147（CC147）中出现高毒力肺炎克雷伯菌（hvKp）菌株

肺炎克雷伯菌是一种公共卫生问题，因为它具有产生多种药物耐药性和高毒力基因型的能力，其中K1和K2型荚膜引起社区和医院危及生命的感染。本研究旨在确定克雷伯菌属菌种的抗生素敏感性模式和基因型性状。隔离株。此外，研究了产生blaNDM的菌株的克隆相关性。在为期19个月的监视研究中，有122克雷伯菌属。从伊朗塞姆南三级转诊医院住院患者的肠外标本中培养分离株。使用生化测试鉴定分离物，并对其进行系统群，荚膜类型和毒力/抗性基因含量的测定。基因型检测到高毒肺炎克雷伯菌（hvKp）菌株，肠道细菌重复基因间共识（ERIC）-PCR指纹图谱用于确定产生blaNDM的菌株的克隆性。在75株（61.5％）分离物中检测到多药耐药表型，发现丁胺卡那霉素是最有效的抗生素，敏感性为85.2％。在45（36.8％）株中检测到碳青霉烯酶基因，包括21（17.2％）blaOXA-48、7（5.6％）blaNDM-1、14（11.4％）blaNDM-1 / OXA-48和3（2.4％）携带blaIMP的菌株，而55株（45.08％）分离株表现出碳青霉烯抗性表型。第一个携带blaNDM-1的菌株于2015年3月从痰标本中培养出来，而最后一个阳性菌株于2016年9月从血液培养物中回收。大多数分离株（80.3％）属于I类群，并且鉴定出blaNDM-1在所有三个系统种群中。ERIC-PCR将101 blaNDM阴性和21 blaNDM-1阳性分离株分别分为25和5个簇，后一组属于克隆复合体147（CC147）。检测到一个K1和15 K2 blaNDM-1阴性分离株，这三个菌株被鉴定为hvKp。5株K2阳性菌株，包括4株blaOXA-48生产者和1株hvKp序列类型86（ST86）对碳青霉烯有抗性。在耐碳青霉烯的菌株中，CC147菌株具有较高的铁载体iutA和ybtS率。目前的发现显示医院流通的CC147 blaNDM-1或blaNDM-1 / OXA-48产菌株在不同病房中传播。迄今为止，伊朗尚未报道表达K2荚膜类型和碳青霉烯抗性表型的hvKp / ST86菌株。因此，似乎我们必须意识到新K的出现和传播。