JPSIM Journal of Pakistan Society of Internal Medicine J Pak Soc Intern Med 2709-8729 2710-0804 Pakistan Society of Internal Medicine 10.70302/jpsim.v7i2.2625 jpsim.v7i2.2625 Original Research Prevalence of Antimicrobial Resistance and Virulent Genes in Hypervirulent Klebsiella Pneumonia Isolates Bukhari Hina hinabukhari46571@import.invalid * Maqsood Rimsha Aftab Khadija Komal Tayyeba drtksami@gmail.com * King Edward Medical University, Mayo Hospital, Lahore, Pakistan Services Institute of Medical Sciences, Lahore. *Correspondence: Hina Bukhari (hinabukhari46571@import.invalid); Tayyeba Komal (drtksami@gmail.com) 03 06 2026 2026 7 2 127 130 26 12 2025 14 04 2026 03 05 2026 Copyright © 2026 The Author(s) 2026 The Author(s) https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective

To determine the antimicrobial resistance and virulence of hypervirulent Klebsiella pneumoniae by phenotypic and genotypic methods.

 Methodology

This was a cross-sectional study done for 6 months at Microbiology department, King Edward Medical University, Lahore. Antimicrobial susceptibility of 76 isolates was assessed,phenotypic string test was performed to check the hypermucoviscosity, and the presence of carbapenem resistance. Presence of genes i.e. New Delhi metallo-β-lactamase-1 (NDM1), extended-spectrum β-lactamase (blaCTX-M-15) and iron uptake chelate A (iucA) encoding aerobactin responsible for virulence was established by PCR.

 Results

Out of 76 patients, 54(71%) were males and 22(29%) were females. Among these 76 isolates 99.5% were Polymyxin B, Colistin (PB, CT) susceptible, 2.6% were gentamycin (CN) and Cefoperazone/sulbactam (SCF) susceptible, 46.1% had Imipenem (IPM) susceptibility and 18.4% had overall susceptibility of PB, CT, IPM, SCF & CN. Whereas, 78.9% isolates showed positive string test. The percentages of genes present were 68.4% iucA, 40.8% blaCTX-M-15 and 19.7% blaNDM. The association of positive string test with the presence of virulent genes was statistically borderline significant for blaCTX-M-15 and significant for blaNDM.

 Conclusion

All the genes analyzed in hvKp isolates including NDM1, blaCTX-M-15 and iucA were prevailing with iucA(78.9%) being most prevalent. In addition to it carbapenems resistance was found to be increasing in hvKp in our study.

 Keywords Hypervirulent Klebsiella pneumoniae antimicrobial resistance prevalence Ethics Statement

Ethics committee: Institutional Review Board, King Edward Medical University, Lahore, Pakistan. Approval number: 158/RC/KEMU, dated December 21, 2023.

 References Wu X, Zhan F, Zhang J, Chen S, Yang B. Identification of hypervirulent Klebsiella pneumoniae carrying terW gene by MacConkey-potassium tellurite medium in the general population. Front Public Health. 2022; 10: 946370. Tang M, Kong X, Hao J, Liu J. Epidemiological Characteristics and Formation Mechanisms of Multidrug-Resistant Hypervirulent Klebsiella pneumoniae. Front Microbiol. 2020;11: 581543. Fursova AD, Fursov MV, Astashkin EI, Novikova TS, Fedyukina GN, Kislichkina AA, et al. Early response of antimicrobial resistance and virulence genes expression in classical, hypervirulent, and hybrid hvKp-MDR Klebsiella pneumoniae on antimicrobial stress. Antibiotics. 2021;11(1):7. Al Balushi M, Kumar R, Al-Rashdi A, Ratna A, Al-Jabri A, Al-Shekaili N, et al. Genomic analysis of the emerging carbapenem-resistant Klebsiella pneumoniae sequence type 11 harbouring Klebsiella pneumoniae carbapenemase (KPC) in Oman. J Infect Public Health. 2022;15(10):1089-96. Umemura T, Kato H, Hagihara M, Hirai J, Yamagishi Y, Mikamo H. Efficacy of Combination Therapies for the Treatment of Multi-Drug Resistant Gram-Negative Bacterial Infections Based on Meta-Analyses. Antibiotics. 2022;11(4):524. Namikawa H, Oinuma K-I, Yamada K, Kaneko Y, Kakeya H, Shuto T. Differences in severity of bacteraemia caused by hypermucoviscous and non-hypermucoviscous Klebsiella pneumoniae. Int J Antimicrob Agents. 2023;61(5):106767. Imtiaz W, Syed Z, Rafaque Z, Andrews SC, Dasti JI. Analysis of antibiotic resistance and virulence traits (genetic and phenotypic) in Klebsiella pneumoniae clinical isolates from Pakistan: identification of significant levels of carbapenem and colistin resistance. Infect Drug Resist. 2021:227-36. Humphries R, Bobenchik AM, Hindler JA, Schuetz AN. Overview of changes to the clinical and laboratory standards institute performance standards for antimicrobial susceptibility testing, M100. J Clin Microbiol. 2021;59(12):10.1128/jcm. 00213-21. Örsten S, Demirci-Duarte S, Ünalan-Altıntop T, Çakar A, Sancak B, Ergünay K, et al. Low prevalence of hypervirulent Klebsiella pneumoniae in Anatolia, screened via phenotypic and genotypic testing. Acta Microbiol Immunol Hungar. 2020;67(2):120-6. Tan TY, Ong M, Cheng Y, Ng LSY. Hypermucoviscosity, rmpA, and aerobactin are associated with community-acquired Klebsiella pneumoniae bacteremic isolates causing liver abscess in Singapore. J Microbiol Immunol Infect. 2019;52(1):30-4. Malik T, Naim A, Saeed A. Molecular detection of TEM, SHV and CTX-M genes among gram-negative Klebsiella isolates. Cur Drug Del. 2018;15(3):417-23. Rashid F, Masood R, Faiz M. Prevalence of New Delhi metallo beta-lactamase (NDM) producing Gram-negative bacteria from different tertiary care hospitals in Lahore, Pakistan. Pak J Zool. 2020;52(3):1209. Yang Y, Liu J-H, Hu X-X, Zhang W, Nie T-Y, Yang X-Y, et al. Clinical and microbiological characteristics of hypervirulent Klebsiella pneumoniae (hvKp) in a hospital from North China. J Infect Develop Count. 2020;14(06):606-13. Kocsis B. Hypervirulent Klebsiella pneumoniae: An update on epidemiology, detection and antibiotic resistance. Acta Microbiol Immunol Hungar. 2023;70(4):278-87. Qian C, Zhang S, Xu M, Zeng W, Chen L, Zhao Y, et al. Genetic and Phenotypic Characterization of Multidrug-Resistant Klebsiella pneumoniae from Liver Abscess. Microbiol Spect. 2023;11(1):e02240-22. Rao SS, Fernandes AM. Detection of hypervirulence genes and drug resistance in Klebsiella pneumoniae in diagnostic microbiology. Scientifica. 2025;8(1):8545710. Vendrik KE, Teunis G, Anema F, Landman F, De Haan A, Bos J, et al. Genomic epidemiology of putative hypervirulent Klebsiella pneumoniae species complex in Dutch patients, January–December 2022. Microbiol Spectr. 2026;14(2):e0225925. Al Ismail D, Campos-Madueno EI, Donà V, Endimiani A. Hypervirulent Klebsiella pneumoniae (hvKp): Overview, Epidemiology, and Laboratory Detection. Pathog Immun. 2025 Jan 24;10(1):80-119. 10.20411/pai.v10i1.777.