Search

Introduction: The objective of this study was to examine the evolution of carbapenem-resistant Klebsiella pneumoniae(CRKp) infections and their impact at a tertiary care hospital in South India. Methods: A comparative analysis of clinical data from two prospective cohorts of patients with CRKp bacteremia (C1, 2014–2015; C2, 2021–2022) was carried out. Antimicrobial susceptibilities and whole genome sequencing (WGS) data of selected isolates were also analyzed. Results: A total of 181 patients were enrolled in the study, 56 from C1 and 125 from C2. CRKp bacteremia shifted from critically ill patients with neutropenia to others (ICU stay: C1, 73%; C2, 54%; p= 0.02). The overall mortality rate was 50% and the introduction of ceftazidime-avibactam did not change mortality significantly (54% versus 48%; p= 0.49). Oxacillinases (OXA) 232 and 181 were the most common mechanisms of resistance. WGS showed the introduction of New Delhi metallo-β-lactamase-5 (NDM-5), higher genetic diversity, accessory genome content, and plasmid burden, as well as increased convergence of hypervirulence and carbapenem resistance in C2. Conclusions: CRKp continues to pose a significant clinical threat, despite the introduction of new antibiotics. The study highlights the evolution of resistance and virulence in this pathogen and the impact on patient outcomes in South India, providing valuable information for clinicians and researchers.

Hypervirulent Klebsiella pneumoniaeinfection, reported commonly from South-east Asia, is predominantly community-acquired and affects young healthy adults. Although abscesses of liver, brain and muscles, endophthalmitis or osteomyelitis have been reported, Infective endocarditis is a rare manifestation. This report illustrates a patient with uncontrolled diabetes mellitus who presented with clinical features of liver abscess with an incidental finding of infective endocarditis. Hypervirulent K. pneumoniae, which was isolated from blood culture of the patient carried the plasmid borne key virulence markers-rmpAand rmpA2with enterobactin (entB), type 3 fimbriae (mrkD) and was of K1 type and ST3321, an uncommon clone of Hypervirulent K. pneumoniae. Transthoracic Echocardiography showed multiple mobile vegetations attached to mitral valve and posterior wall of left ventricle. With appropriate antibiotics blood cultures turned sterile, liver abscess and cardiac vegetations reduced in size. Mitral Valve replacement surgery was proposed. He declined treatment and succumbed to the infection subsequently.