The overlap of accessory virulence factors and multidrug resistance among clinical and surveillance Klebsiella pneumoniae isolates from a neonatal intensive care unit in Nepal: a single-centre experience in a resource-limited setting

<jats:title>Abstract</jats:title><jats:sec> <jats:title>Background</jats:title> <jats:p>There is a lack of data on the characteristics of overlap between acquired antimicrobial resistance and virulence factors in <jats:italic>Klebsiella pneumoniae</jats:italic> in high-risk settings, especially with the inclusion of surveillance isolates along with the clinical. We investigated <jats:italic>K. pneumoniae</jats:italic> isolates, from a neonatal intensive care unit (NICU) in Nepal, for the presence of both accessory virulence factors and acquired antimicrobial resistance.</jats:p> </jats:sec><jats:sec> <jats:title>Methods</jats:title> <jats:p>Thirty-eight clinical and nineteen surveillance <jats:italic>K. pneumoniae</jats:italic> isolates obtained between January 2017 and August 2022 in the NICU of Siddhi Memorial Hospital, Bhaktapur, Nepal were investigated with antimicrobial susceptibility testing, PCR-based detection of β-lactamases and virulence factors, and genetic similarity by ERIC–PCR.</jats:p> </jats:sec><jats:sec> <jats:title>Results</jats:title> <jats:p><jats:italic>K. pneumoniae</jats:italic> was found positive in 37/85 (43.5%) blood culture-positive neonatal bloodstream infections, 34/954 (3.6%) patient surveillance cultures, and 15/451 (3.3%) environmental surveillance samples. Among 57 isolates analyzed in this study, we detected multidrug resistance in 37/57 (64.9%), which was combined with at least one accessory virulence factor in 21/37 (56.8%). This overlap was mostly among β-lactamase producing isolates with accessory mechanisms of iron acquisition. These isolates displayed heterogenous ERIC–PCR patterns suggesting genetic diversity.</jats:p> </jats:sec><jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The clinical significance of this overlap between acquired antimicrobial resistance and accessory virulence genes in <jats:italic>K. pneumoniae</jats:italic> needs further investigation. Better resource allocation is necessary to strengthen infection prevention and control interventions in resource-limited settings.</jats:p> </jats:sec>