Low incidence of hypervirulent clinical klebsiella pneumoniae producing carbapenemases among Jordanian hospitalized patients


  • Abd AlRahman M. Al Mahasneh The Jordan University, Amman
  • Azmi M. Mahafzah The Jordan University
  • Asem A. Shehabi




K.pneumoniae, virulence factors, antimicrobial susceptibility, Jordanian patients


Background:  Klebsiella species are widely present in the environment and colonize mucosal surfaces of humans. The organism is responsible for various community and hospital-acquired infections. Increased incidence of isolates producing K .pneumoniae carbapenemases (KPCs)  in infected patients has become a significant problem in many countries, especially those new hypervirulent clinical variant (hvKP).  This prospective study was intended to detect the incidence, virulence factors and carbapenems resistant gene (blakpc2) in K. pneumoniae isolates among Jordanian patients.

Methods:  A total of 104 klebsiella species isolates were collected randomly from three major hospitals in Amman, Jordan, over the period from September 2012 to October 2013. These isolates were investigated for incidence of  K.pneumoniae , antimicrobial susceptibility and detection of virulence factors and kpc gene using PCR .

Results: A total of 75 (72%) of the collected isolates were confirmed as K. pneumoniae using PCR, and 74% of these were MDR to at least 3 antibiotic classes. The percentage of the virulence factors K1, K2, K5, rmpA and aerobactin were 0%, 4%, 0%, 5.3% and 10.7%, respectively. Resistant to cabapenems was detected in 18/75 (24% ) of K . pneumoniae isolates, and 10 (13.3%) of these have the kpc genes .

Conclusion: This study confirms the high incidence rate of MDR K. pneumoniae and low incidence of (KPCs) isolates in Jordanian patients.  There were few isolates associated with virulence factor genes causing hvKP, and no significant correlation demonstrated between the presence of virulence factors and kpc gene in these isolates.

Author Biographies

Abd AlRahman M. Al Mahasneh, The Jordan University, Amman

Department of Patholog-Microbiology, Prof.

Azmi M. Mahafzah, The Jordan University

Department of Pathology-Microbiology


Pomakova, D. K., Hsiao, C. B., Beanan, J. M., Olson, R., MacDonald, U., Keynan, Y., & Russo, T. A. Clinical and phenotypic differences between classic and hypervirulent Klebsiella pneumonia: an emerging and under-recognized pathogenic variant. Eur J Clin Microbiol Infect Dis 2012, 31:981-989.

Hirsch, E. B., & Tam, V. H. Detection and treatment options for Klebsiella pneumoniae carbapenemases (KPCs): an emerging cause of multidrug-resistant infection. J Antimicrob Chemother 2010; 65(6):1119-25.

Woodford, N., P. M. Tierno, Jr., K. Young, L. Tysall, M. F. I. Papelou, et al. Outbreak of Klebsiella pneumoniae producing a new carbapenem-hydrolyzing class A -lactamase, KPC-3. Antimicrob Agents Chemother 2004; 48:4793–4799.

Chen, L. F., Anderson, D. J., Paterson, D. L. Overview of the epidemiology and the threat of Klebsiella pneumoniae carbapenemases (KPC) resistance. Infect Drug Resist 2012; 5: 133.

Shon, A. S., & Russo, T. A. Hypervirulent Klebsiella pneumoniae: the next superbug ?. Future Microbiol 2012;7(6), 669-671.

Fang, C.T.,Chuang,Y.P.,Shun,C.T.,Chang,S.C.,andWang,J.T. A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exper Med 2004;199:697–705.

Clinical and Laboratory Standards Institute (CLSI). Performance standards

for antimicrobial susceptibility testing. 23nd Informational Supplement. M100-S23.

Wayne, PA: CLSI, 2013.

Chander,Y , Ramakrishnan, M.A ,Jindal,N , Hanson, K , Goyal, S M. Differentiation of Klebsiella pneumoniae and K.oxytoca by Multiplex Polymerase Cain Reaction .Intern J Appl Res Vet Med 2011; .9:2-8.

Siu, L. K., Fung, C., Chang ,F. et al. Molecular typing and virulence analysis of serotype K1 Klebsiella pneumoniae strains isolated from liver abscess patients and stool samples from noninfectious subjects in Hong Kong, Singapore, and Taiwan,†J Clin Microbiol 2011;49:3761–3765.

Yigit, H., Queenan, A.M., Anderson, G.J. et al. Novel carbapenem-hydrolyzing b-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother 2001;45:1151–61.

Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis. 2009 Apr;9(4):228-36.

Nordmann P, Dortet L, Poirel L. Carbapenem resistance in Enterobacteriaceae:

here is the storm! Trends Mol Med 2012; 18: 263–272.

Randa Kattan1 , Rawan Liddawi1 , Raed Ghneim , Issa Siryani , Rula Al-Dawodi et al. Emergence of Klebsiella pneumoniae Carbapenemase (blakpc2) in members of the Enterobacteriaceae family in Palestine. IAJAA 2012; 2: 4, 1-9.

Taher uz Zaman, Mohammed Aldrees, Sameera M. Al Johani, Maha Alrodayyan Faizah A. Aldughashem, Hanan H. Balkhy. Multi-drug carbapenem-resistant Klebsiella pneumoniae infection carrying the OXA-48 gene and showing variations in outer membrane protein 36 resulting in an outbreak in a tertiary care hospital in Riyadh, Saudi Arabia. Int J Infect Dis. 2014;28:186-92.

G. M. Matar1 , G. Cuzon , G. F. Araj , T. Naas , J. Corkill , M. M. Kattar, P. Nordmann. Oxacillinase-mediated resistance to carbapenems in Klebsiella pneumoniae from Lebanon. CMI 2008;14: 887–888.

Shanmugam, P., Meenakshisundaram, J., & Jayaraman, P. BlaKPC gene Detection in Clinical Isolates of Carbapenem Resistant Enterobacteriaceae in a Tertiary Care Hospital. Journal of clinical and diagnostic research: JCDR 2013; 7(12):2736.

Xuan Wang, Gongxiang Chen, Xiaoyan Wu, Liangping Wang, Jiachang Cai, et al. Increased prevalence of carbapenem resistant Enterobacteriaceae in hospital setting due to cross-species transmission of the blaNDM-1element and clonal spread of progenitor resistant strains. Front Microbil 2015; 6:595

Queenan, A. M., & Bush, K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev 2007; 20(3):440-458.

Tumbarello M, Viale P, Bassetti M, De Rosa FG, Spanu T, Viscoli C, et al. Infections caused by KPC-producing Klebsiella pneumoniae: differences in therapy and mortality in a multicentre study. J Antimicrob Chemother 2015;70(10):2922.

Patel PK, Russo TA, Karchmer AW. Hypervirulent Klebsiella pneumoniae. Open Forum Infect Dis. 2014;2;1(1).

Li W, Sun G, Yu Y, et al. Increasing occurrence of antimicrobial resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China. Clin Infect Dis 2014;58:225–32.







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