Detection of hypervirulent and classical type of Klebsiella pneumoniae and screening their resistant properties in Erbil city

Hypervirulent and Classical Klebsiella pneumoniae from clinical isolates in Erbil City


  • Sima A. Zuber Department of Pharmacognosy, College of Pharmacy, Hawler Medical University Erbil, Iraq.
  • Aryan R. Ganjo 1. Department of Clinical Analysis, College of Pharmacy, Hawler Medical University, Erbil, Iraq/ 2. Department of Medical Analysis, Faculty of Applied Science, Tishk International University, Erbil, Iraq.



Hypervirulent Klebsiella pneumoniae (hvKp), Classical Klebsiella pneumoniae (cKp), Carbapenem-resistant, Extended-spectrum beta-lactamase (ESBL), Serum Resistant


Background and objective: Klebsiella pneumoniaei s an opportunistic pathogenic bacterium and is considered one of the main causes of nosocomial infection. Hypervirulent K. pneumoniae (hvKp) has emerged as a pathogen of global importance. The current study aimed to determine Extended-spectrum beta-lactamase, carbapenem resistance, and serum bactericidal effect among the clinical isolates and to find the relationship of the above features with antimicrobial resistance.

Methods: A total of 90 K. pneumoniae isolates were collected from different clinical specimens. Isolates were diagnosed using routine bacteriological methods and VITEK 2 compact system. Several phenotypic tests including string test, serum resistant, ESBL test, and Modified Carbapenem inactivation method were performed. The antibiotic resistance pattern was compared among ESBL-positive, carbapenem-resistant in both Hypervirulent (hvKp) and classical K. pneumoniae (cKp) isolates.

Results: The results revealed that among 90 isolates, 56.7% of the isolates were of classical K. pneumoniae (cKp) type within which 70.6% of them were ESBL positive, 37.3% of them were resistant to carbapenem, and 51% were resistant to serum bactericidal activity. On the other hand, 43.3% were of hvKp type within which 61.5% of them were ESBL positive, 30.8% were carbapenem-resistant and all of the hvKp were resistant to human serum. The rate of antibiotic-resistant among cKp was higher than hvKp isolates.

Conclusion: In this study, classical strains were more resistant to antibiotics and the rates of ESBL and Carbapenem resistance were higher compared to hvKp strains. but they were killed by serum bactericidal activities more rapidly.


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Melot B, Colot J, Guerrier G. Bacteremic community-acquired infections due to Klebsiella pneumoniae: clinical and microbiological presentation in New Caledonia, 2008–2013. Int J Infect Dis 2015; 41:29–31. https://doi.10.1016/j.ijid.2015.10.013.

Chen D, Zhang Y, Wu J, Analysis of hypervirulent Klebsiella pneumoniae and classic Klebsiella pneumoniae infections in a Chinese hospital. J Appl Microbiol 2022; 132(5):3883–90. https://doi: 10.1111/jam.15476.

Prokesch BC, TeKippe M, Kim J, Raj P, TeKippe EM, Greenberg DE. Primary osteomyelitis caused by hypervirulent Klebsiella pneumoniae. Lancet Infect Dis. 2016; 16(9):e190–e5. https://doi: 10.1016/S1473-3099(16)30021-4.

Liu C, Guo J. Hypervirulent Klebsiella pneumoniae (hypermucoviscous and aerobactin positive) infection over 6 years in the elderly in China: antimicrobial resistance patterns, molecular epidemiology and risk factor. Ann Clin Microbiol Antimicrob 2019; 18(1):1–11. https:// doi: 10.1186/s12941-018-0302-9.

Zhang Y, Zeng J, Liu W, Emergence of a hypervirulent carbapenem-resistant Klebsiella pneumoniae isolate from clinical infections in China. J Infect 2015; 71(5):553–60. https:// doi: 10.1016/j.jinf.2015.07.010.

Wang G, Zhao G, Chao X, Xie L, Wang H. The characteristic of virulence, biofilm and antibiotic resistance of Klebsiella pneumoniae. Int J Environ Res Public Health. 2020; 17(17):6278. https://doi: 10.3390/ijerph17176278.

Shah RK, Ni ZH, Sun XY, Wang GQ, Li F. The determination and correlation of various virulence genes, ESBL, serum bactericidal effect and biofilm formation of clinical isolated classical Klebsiella pneumoniae and hypervirulent Klebsiella pneumoniae from respiratory tract infected patients. Pol J Microbiol 2017; 66(4). https:// doi: 10.5604/01.3001.0010.7042.

Feng Y, Lu Y, Yao Z, Zong Z. Carbapenem-resistant hypervirulent Klebsiella pneumoniae of sequence type 36. Antimicrob Agents Chemother 2018; 62(7):e02644–17. https://doi: 10.1128/AAC.02644-17.

Zhan L, Wang S, Guo Y. Outbreak by hypermucoviscous Klebsiella pneumoniae ST11 isolates with carbapenem resistance in a tertiary hospital in China. Front. Cell. Infect. Microbiol 2017; 7:182.

Sfeir M, Hayden J, Fauntleroy K. EDTA-modified carbapenem inactivation method: a phenotypic method for detecting metallo-β-lactamase-producing Enterobacteriaceae. J Clin Microbiol 2019; 57(5):e01757. https://doi: 10.1128/JCM.01757-18.

Tamma PD, Goodman KE, Harris AD. Comparing the outcomes of patients with carbapenemase-producing and non-carbapenemase-producing carbapenem-resistant Enterobacteriaceae bacteremia. Clin Infect Dis 2017; 64(3):257–64. https://doi:10.1093/cid/ciw741.

Mahmoudi S, Mahzari M, Banar M. Antimicrobial resistance patterns of Gram-negative bacteria isolated from bloodstream infections in an Iranian referral paediatric hospital: A 5.5-year study. J Glob Antimicrob Resist 2017; 11:17–22. https://doi: 10.1016/j.jgar.2017.04.013.

Morales-León F, Opazo-Capurro A, Caro C. Hypervirulent and hypermucoviscous extended-spectrum β-lactamase-producing Klebsiella pneumoniae and Klebsiella variicola in Chile. Virulence 2021; 12(1):35–44. https://doi:10.1080/21505594.2020.1859274.

Koksal E, Tulek N, Sonmezer MC, Temocin F, Bulut C, et al. Investigation of risk factors for community-acquired urinary tract infections caused by extended-spectrum beta-lactamase Escherichia coli and Klebsiella species. Investig Clin Urol 2019; 60(1):46–53.

Tsai Y-M, Wang S, Chiu H-C, Kao C-Y, Wen L-L. Combination of modified carbapenem inactivation method (mCIM) and EDTA-CIM (eCIM) for phenotypic detection of carbapenemase-producing Enterobacteriaceae. BMC Microbio 2020; 20(1):1–7.

Liu Y, Bai J, Kang J. Three Novel Sequence Types Carbapenem-Resistant Klebsiella pneumoniae Strains ST5365, ST5587, ST5647 Isolated from Two Tertiary Teaching General Hospitals in Shanxi Province, in North China: Molecular Characteristics, Resistance and Virulence Factors. Infect Drug Resist 2022; 15:2551–63. https://doi: 10.2147/IDR.S366480.

Soliman AS, Agban MN. An Updated Outline of Klebsiella pneumoniae Resistance: Mechanisms and Treatments. Egyptian J Med Microbio 2022; 31(2):127–36. https://doi: 10.21608/ EJMM.2022.229672.

Mohammed KAM, Elhag SAA, Ahmed STE, Gorish BM, Mohammed SO. Molecular Detection of Virulence genes (rmpA2, iuc & iroB) of Hypervirulent Klebsiella pneumoniae in Clinical Isolates from Patients in Khartoum State, Sudan Asian J Infect Dis 9(4):23–31, 2022. https://doi:10.9734/AJRID/2022/v9i430275

Li W, Sun G, Yu Y. Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China.Clin Infect Dis 2014; 58(2):225–32. https:// doi: 10.1093/cid/cit675.

Chang W-N, Huang C-R, Lu C-H, Chien C-C. Adult Klebsiella pneumoniae meningitis in Taiwan: an overview. Acta Neurol Taiwan 2012; 21(2):87–96.

Sanikhani R, Moeinirad M, Solgi H, Hadadi A, Shahcheraghi F, Badmasti F. The face of hypervirulent Klebsiella pneumoniae isolated from clinical samples of two Iranian teaching hospitals. Annals Clin Microbiol Antimicrob 2021; 20(1):1–13. https://doi:10.1186/s12941-021-00467-2.

Rastegar S, Moradi M, Kalantar-Neyestanaki D, Hosseini-Nave H. Virulence factors, capsular serotypes and antimicrobial resistance of hypervirulent Klebsiella pneumoniae and classical Klebsiella pneumoniae in Southeast Iran. Infect Chemother. 2019; 51.

Parrott A, Shi J, Aaron J, Green D, Whittier S, Wu F. Detection of multiple hypervirulent Klebsiella pneumoniae strains in a New York City hospital through screening of virulence genes. Clin Microbiol and Infect 2021; 27(4):583–9.

Tang M, Kong X, Hao J, Liu J. Epidemiological characteristics and formation mechanisms of multidrug-resistant hypervirulent Klebsiella pneumoniae. Front Microbiol 2020; 11:2774.

Gu D, Dong N, Zheng Z. A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study. Lancet Infect Dis. 2018; 18(1):37–46. https://doi:10.1016/S1473-3099(17)30489-9.

Taraghian A, Esfahani BN, Moghim S, Fazeli H. Characterization of hypervirulent extended-spectrum β-lactamase-producing Klebsiella pneumoniae among urinary tract infections: the first report from Iran. Infect Drug Resist 2020; 13:3103. https://doi: 10.2147/IDR.S264440.

Remya P, Shanthi M, Sekar U. Occurrence and characterization of hyperviscous K1 and K2 serotype in Klebsiella pneumoniael. J Lab Physicians 2018; 10(03):283–8. https://doi:10.4103/JLP.JLP_48_18.

Hasani A, Soltani E, Rezaee MA. Serotyping of Klebsiella pneumoniae and its relation with capsule-associated virulence genes, antimicrobial resistance pattern, and clinical infections: a descriptive study in medical practice. Infect Drug Resist 2020; 13:1971.

Gorrie CL, Mirčeta M, Wick RR. Genomic dissection of Klebsiella pneumoniae infections in hospital patients reveals insights into an opportunistic pathogen. Nature Communications. 2022; 13(1):1–17.

Ahmed HJ, Ganjo AR. Detection of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli recovered from clinical specimens in Erbil City Kurdistan Region of Iraq. Al-Mustansiriyah J of Science 2019; 30(2):10–8.

Zhou C, Wu Q, He L. Clinical and molecular characteristics of carbapenem-resistant hypervirulent klebsiella pneumoniae isolates in a tertiary hospital in Shanghai, China. Infect Drug Resist 2021; 14:2697.

Samanje J, Mohammed AS, Al-Hamami MS. Phenotypic and Genotypic Detection of Extended-spectrum β-lactamase production by Klebsiella pneumoniae Isolated from Different Clinical Samples in Baghdad, Iraq. J Pure Appl Microbiol 2021.




How to Cite

A. Zuber, S., & R. Ganjo, A. . (2023). Detection of hypervirulent and classical type of Klebsiella pneumoniae and screening their resistant properties in Erbil city : Hypervirulent and Classical Klebsiella pneumoniae from clinical isolates in Erbil City. Zanco Journal of Medical Sciences (Zanco J Med Sci), 27(3), 329–339.



Original Articles