Detection of hypervirulence genes in carbapenem resistant Klebsiella pneumoniae from cancer patients at a tertiary referral hospital in Nepal

Carbapenem-resistant Klebsiella pneumoniae (CRKP) are a serious public health threat and is linked to high mortality, particularly in immunocompromised and critically ill patients. In addition, hyper-virulent K. pneumoniae (hvKP) variants contributing to severe clinical outcomes in cancer patients. This study aims to identify carbapenem-resistant K. pneumoniae isolates from cancer patients and detect associated hypervirulence genes. Clinical specimens were collected from cancer patients and processed for bacterial isolation and identification by conventional method. The antibiotic susceptibility testing was performed using Kirby Bauer disk diffusion method following CLSI guideline. All carbapenem-resistant K. pneumoniae isolates were further analyzed for carbapenemase production using the modified carbapenem inactivation method (mCIM) and metallo-β-lactamase (MBL) production using the EDTA-modified carbapenem inactivation method (eCIM). The presence of carbapenemase and hypervirulence encoding genes in CRKP were confirmed by polymerase chain reaction (PCR). All data were analyzed using SPSS. The chi-square test was applied to assess associations, and a p-value < 0.05 was considered statistically significant at a 95% confidence interval. Out of 4273 samples, bacterial growth was observed in 23% (987/4273) with a total of 1016 bacterial isolates, including polymicrobial growth. A total of 23.7% (241/1016) of K. pneumoniae isolates were retrieved from 241 cancer patients. Carbapenem-resistant K. pneumoniae (CRKP) isolates were detect in 53.5% (129/241), with 38% (49/129) of blaNDM−1 as predominant carbapenemase gene. Among hypervirulence markers, iucA (66.7%, 86/129) was the most prevalent. Co-occurrence of carbapenem resistance genes and hypervirulence genes was detected in 21% (27/129) among CRKP. Effective intervention strategies are crucial to enhance the timely clinical recognition and optimal management of CRKP and hvKP infections.