Hypervirulent Klebsiella pneumoniae infections in Vancouver, Canada: a clinical, microbiological, and genetic retrospective investigation

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ID: 331887
2026
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Abstract
Abstract Background Hypervirulent Klebsiella pneumoniae (hvKp) is poorly characterized in North America and likely underrecognized. We evaluated a molecular screening approach for hvKp and described the clinical, microbiological, and genomic characteristics of hvKp isolates in Vancouver, Canada. Methods We conducted a retrospective study of sterile-site Kp isolates recovered at a tertiary care center (2018-2024). Archived isolates were screened using PCR targeting peg-344 and iucA. Whole-genome sequencing was then performed with hvKp defined as a Kleborate virulence score ≥3. Clinical data were obtained through chart review. Genomic relatedness was assessed using reference-based multilocus sequence typing. Results Among 449 isolates, 43 were PCR-positive for peg-344 and/or iucA, and 38 met criteria for hvKp. Only five (13%) cases were suspected at the time of isolation. The molecular screen demonstrated 100% sensitivity and 98.8% specificity for hvKp detection. Compared with classical Kp, hvKp infection was independently associated with travel history (aOR 9.73; 95% CI 2.06-46.04) and residence in Vancouver’s Downtown Eastside (DTES; aOR 3.69 ; 95% CI 1.05-12.97), but not with Indo-Pacific country of origin (aOR 1.77; 95% CI 0.49-6.37). Genomic analysis suggested possible local transmission between two DTES patients. K1/K2 were the most common capsular serotypes. One ST15 hvKp isolate carried blaNDM, representing a convergent hypervirulent and carbapenem-resistant strain. Conclusion Routine molecular screening improved detection of hvKp and revealed evolving epidemiology, including possible clonal transmission. Implementing laboratory-based molecular screening can enhance clinical recognition, guide evaluation for metastatic complications, and monitor the emergence of high-risk strains.
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Authors Emma CL Finlayson-Trick, Aleksandra Stefanovic, Michael Payne, Leah Gowland, Jennifer Bilawka, Gordon Ritchie, Samuel D. Chorlton, Nancy Matic, Victor Leung, Laura F. Mataseje, Marc G. Romney, Christopher F. Lowe, Patrick Tang
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Journal Open forum infectious diseases
Year 2026
DOI
10.1093/ofid/ofag654
URL
https://doi.org/10.1093/ofid/ofag654
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