The emergence of multidrug-resistant (MDR) Klebsiella pneumoniae undermines treatment efficacy, while limited genomic epidemiological data constrain understanding of local transmission dynamics. We therefore aimed to investigate the genomic epidemiology and the antimicrobial resistance landscape of K. pneumoniae in tertiary-care settings in Peshawar, Pakistan. A total of 497 clinical samples (urine, blood, sputum, pus, wound swabs, sterile body fluids) were collected from 01 August 2024 to 31 July 2025. K. pneumoniae was identified using the API 20E kit, followed by antimicrobial susceptibility testing (AST), with colistin and tigecycline susceptibility determined by broth microdilution. Whole-genome sequencing (WGS) was carried out on 43 MDR and XDR isolates to resolve clonal diversity, resistome composition, virulence-associated loci, and phylogenetic relationships. Among 497 samples, 152 K. pneumoniae isolates were identified, exhibiting widespread resistance to β-lactams, cephalosporins, fluoroquinolones, aminoglycosides, and carbapenems, while colistin and tigecycline retained substantial in vitro activity. Overall, 37% and 24% of isolates were classified as MDR and XDR, respectively. Forty-three MDR/XDR isolates were subjected to WGS, of which 34 high-quality K. pneumoniae genomes passed quality control and species verification for downstream analysis. Genomic analysis identified 18 sequence types, with ST147 (7/34, 20.6%), ST37 (4/34, 11.8%), ST2629 (3/34, 8.8%), ST39 (3/34, 8.8%), and ST870 (2/34, 5.9%) representing the predominant lineages. The dominant high-risk clones, particularly ST147, ST11, ST231, and ST42-3LV, harbored multiple antimicrobial resistance determinants, including blaCTX-M-15 (20/34) or blaCTX-M-14 (2/34), blaKPC-2 (2/34), blaOXA-48 (1/34), blaOXA-181 (1/34), blaNDM-5 (1/34), aminoglycoside-modifying enzymes, fluoroquinolone resistance determinants, porin disruptions (ompK35/ompK36; 9/34), and colistin resistance–associated mutations in pmrB in 4 isolates. ST147 was the predominant lineage and was consistently associated with the KL64 capsule type and O1/O2-associated O-loci. Virulence profiling demonstrated a predominantly low-virulence population, with 19/34 (55.9%) isolates carrying yersiniabactin as the only detected virulence determinant, whereas aerobactin, colibactin, and rmpA/rmpA2 were absent from all genomes. Collectively, these findings demonstrate that MDR K. pneumoniae circulating in Peshawar are dominated by internationally disseminated high-risk clones characterized by extensive antimicrobial resistance but limited virulence potential, underscoring the importance of genomic surveillance to strengthen infection prevention and antimicrobial stewardship.
Citation: Aiman Waheed, Sumera Afzal Khan, Taj Ali Khan, Sajjad Ahmad, Aakash Ahmad Khattak, Taane G. Clark, Nigel G. Ternan, Fahad Ahmed, Ibrahim M. Banat, Zahoor Khan. Genomic epidemiology of multidrug-resistant Klebsiella pneumoniae reveals lineage-specific resistance patterns with limited virulence determinants[J]. AIMS Microbiology, 2026, 12(3): 610-631. doi: 10.3934/microbiol.2026027
The emergence of multidrug-resistant (MDR) Klebsiella pneumoniae undermines treatment efficacy, while limited genomic epidemiological data constrain understanding of local transmission dynamics. We therefore aimed to investigate the genomic epidemiology and the antimicrobial resistance landscape of K. pneumoniae in tertiary-care settings in Peshawar, Pakistan. A total of 497 clinical samples (urine, blood, sputum, pus, wound swabs, sterile body fluids) were collected from 01 August 2024 to 31 July 2025. K. pneumoniae was identified using the API 20E kit, followed by antimicrobial susceptibility testing (AST), with colistin and tigecycline susceptibility determined by broth microdilution. Whole-genome sequencing (WGS) was carried out on 43 MDR and XDR isolates to resolve clonal diversity, resistome composition, virulence-associated loci, and phylogenetic relationships. Among 497 samples, 152 K. pneumoniae isolates were identified, exhibiting widespread resistance to β-lactams, cephalosporins, fluoroquinolones, aminoglycosides, and carbapenems, while colistin and tigecycline retained substantial in vitro activity. Overall, 37% and 24% of isolates were classified as MDR and XDR, respectively. Forty-three MDR/XDR isolates were subjected to WGS, of which 34 high-quality K. pneumoniae genomes passed quality control and species verification for downstream analysis. Genomic analysis identified 18 sequence types, with ST147 (7/34, 20.6%), ST37 (4/34, 11.8%), ST2629 (3/34, 8.8%), ST39 (3/34, 8.8%), and ST870 (2/34, 5.9%) representing the predominant lineages. The dominant high-risk clones, particularly ST147, ST11, ST231, and ST42-3LV, harbored multiple antimicrobial resistance determinants, including blaCTX-M-15 (20/34) or blaCTX-M-14 (2/34), blaKPC-2 (2/34), blaOXA-48 (1/34), blaOXA-181 (1/34), blaNDM-5 (1/34), aminoglycoside-modifying enzymes, fluoroquinolone resistance determinants, porin disruptions (ompK35/ompK36; 9/34), and colistin resistance–associated mutations in pmrB in 4 isolates. ST147 was the predominant lineage and was consistently associated with the KL64 capsule type and O1/O2-associated O-loci. Virulence profiling demonstrated a predominantly low-virulence population, with 19/34 (55.9%) isolates carrying yersiniabactin as the only detected virulence determinant, whereas aerobactin, colibactin, and rmpA/rmpA2 were absent from all genomes. Collectively, these findings demonstrate that MDR K. pneumoniae circulating in Peshawar are dominated by internationally disseminated high-risk clones characterized by extensive antimicrobial resistance but limited virulence potential, underscoring the importance of genomic surveillance to strengthen infection prevention and antimicrobial stewardship.
| [1] |
Aldali JA (2025) Klebsiella pneumoniae: A multidrug-resistant pathogen has emerged in Saudi Arabia. Front Microbiol 16: 1689974. https://doi.org/10.3389/fmicb.2025.1689974 
|
| [2] |
Huang X, Yao X, Hou Y, et al. (2025) Global trends of antimicrobial resistance and virulence of Klebsiella pneumoniae from different host sources. Commun Med 5: 383. https://doi.org/10.1038/s43856-025-01112-1
|
| [3] |
García-Cobos S, Oteo-Iglesias J, Pérez-Vázquez M (2025) Hypervirulent Klebsiella pneumoniae: Epidemiology outside Asian countries, antibiotic resistance association, methods of detection and clinical management. Enferm Infecc Microbiol Clin 43: 102-109. https://doi.org/10.1016/j.eimce.2024.12.008
|
| [4] |
Choby JE, Howard-Anderson J, Weiss DS (2020) Hypervirulent Klebsiella pneumoniae—clinical and molecular perspectives. J Intern Med 287: 283-300. https://doi.org/10.1111/joim.13007
|
| [5] |
Wang Q, Ye MY, Hong C, et al. (2025) The mechanisms of resistance, epidemiological characteristics, and molecular evolution of carbapenem-resistant hypervirulent Klebsiella pneumoniae. Lab Med 56: 323-335. https://doi.org/10.1093/labmed/lmae110
|
| [6] |
Chen TA, Chuang YT, Lin CH (2024) A decade-long review of the virulence, resistance, and epidemiological risks of Klebsiella pneumoniae in ICUs. Microorganisms 12: 2548. https://doi.org/10.3390/microorganisms12122548
|
| [7] |
Le Bris J, Chen N, Supandy A, et al. (2025) Phage therapy for Klebsiella pneumoniae: Understanding bacteria–phage interactions for therapeutic innovations. PLoS Pathog 21: e1012971. https://doi.org/10.1371/journal.ppat.1012971
|
| [8] |
Stanton TD, Keegan SP, Abdulahi JA, et al. (2026) Distribution of capsule and O types in Klebsiella pneumoniae causing neonatal sepsis in Africa and South Asia: A meta-analysis of genome-predicted serotype prevalence to inform potential vaccine coverage. PLoS Med 23: e1004879. https://doi.org/10.1371/journal.pmed.1004879
|
| [9] |
Karampatakis T, Tsergouli K, Behzadi P (2023) Carbapenem-resistant Klebsiella pneumoniae: Virulence factors, molecular epidemiology and latest updates in treatment options. Antibiotics 12: 234. https://doi.org/10.3390/antibiotics12020234
|
| [10] |
Mishra P, Sahoo D, Sahu MC (2025) Genetic diversity and antimicrobial resistance of clinical Klebsiella pneumoniae isolates: An ISSR-PCR analysis. J Infect Public Health 18: 102813. https://doi.org/10.1016/j.jiph.2025.102813
|
| [11] |
Spadar A, Perdigão J, Campino S, et al. (2023) Large-scale genomic analysis of global Klebsiella pneumoniae plasmids reveals multiple simultaneous clusters of carbapenem-resistant hypervirulent strains. Genome Med 15: 3. https://doi.org/10.1186/s13073-023-01153-y
|
| [12] | Maguire M (2025) Carbapenem resistance and hypervirulence in Enterobacterales: A genomic and phylogenetic analysis of clinical and environmental isolates in Ireland. Ireland: Ph. D. Theses, University of Galway. https://doi.org/10.13025/30122 |
| [13] | El Sharief H, Ali SM, Mohamed S, et al. (2025) Prevalence of carbapenemase genes blaOXA-48, blaNDM, and blaIMP in multidrug-resistant Pseudomonas aeruginosa and Klebsiella pneumoniae clinical isolates from University Hospital Sharjah, UAE. Int J Biomedicine 15: 731-735. https://doi.org/10.21103/Article15(4)_OA14 |
| [14] |
Zhang Z, Wang D, Li Y, et al. (2022) Comparison of the performance of phenotypic methods for the detection of carbapenem-resistant Enterobacteriaceae (CRE) in clinical practice. Front Cell Infect Microbiol 12: 849564. https://doi.org/10.3389/fcimb.2022.849564
|
| [15] |
Maryam S, Saleem Z, Haseeb A, et al. (2025) Progress on the global research agenda for antimicrobial resistance in human health in Pakistan: Findings and implications. Infect Drug Resist 18: 3795-3828. https://doi.org/10.2147/IDR.S531874
|
| [16] | Ashraf Z, Hidayat Rasool M, Khurshid M, et al. (2025) Antimicrobial resistance and virulence profiling of Klebsiella pneumoniae isolated from urinary tract infections in community and hospital settings in Pakistan. Pak J Pharm Sci 38: 395-405. https://doi.org/10.36721/PJPS.2025.38.2.REG.13975.1 |
| [17] |
Rizvi M, Khan N, Fatima A, et al. (2025) The microbiological characteristics and genomic surveillance of carbapenem-resistant Klebsiella pneumoniae isolated from clinical samples. Microorganisms 13: 1577. https://doi.org/10.3390/microorganisms13071577
|
| [18] |
Somda NS, Nyarkoh R, Kotey FCN, et al. (2024) A systematic review and meta-analysis of carbapenem-resistant Enterobacteriaceae in West Africa. BMC Med Genomics 17: 267. https://doi.org/10.1186/s12920-024-02043-x
|
| [19] |
Haley E, Cockerill FR, Pesano RL, et al. (2024) Pooled antibiotic susceptibility testing performs within CLSI standards for validation when measured against broth microdilution and disk diffusion antibiotic susceptibility testing of cultured isolates. Antibiotics 13: 1214. https://doi.org/10.3390/antibiotics13121214
|
| [20] |
Smriti S, Panda SS, Dash RK, et al. (2025) Antibiogram of Escherichia coli and Klebsiella pneumoniae urinary isolates and susceptibility of amikacin in extended-spectrum beta-lactamase producers. J Pure Appl Microbiol 19: 714-722. https://doi.org/10.22207/JPAM.19.1.62
|
| [21] | Narayan M, Mohapatra S, Das B, et al. (2025) Rapid identification and susceptibility testing directly from urine specimens, reducing turnaround time, a step towards advancing diagnostic stewardship. Cureus 17: e93441. https://doi.org/10.7759/cureus.93441 |
| [22] |
Magiorakos AP, Srinivasan A, Carey RB, et al. (2012) Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18: 268-281. https://doi.org/10.1111/j.1469-0691.2011.03570.x
|
| [23] |
Thapa TB, Maharjan S, Giri N, et al. (2025) Incidence of hypermucoviscous Klebsiella pneumoniae and phenotypic detection of their virulence factors along with classical strains among patients visiting tertiary care hospital. J Infect Dev Countr 19: 258-266. https://doi.org/10.3855/jidc.19456
|
| [24] |
Lad V, Panchal D, Pithawala M, et al. (2022) Determination of hemolytic activity. Biosafety Assessment of Probiotic Potential . New York: Humana 43-46. https://doi.org/10.1007/978-1-0716-2509-5_6
|
| [25] |
Quainoo S, Coolen JPM, van Hijum SAFT, et al. (2017) Whole-genome sequencing of bacterial pathogens: The future of nosocomial outbreak analysis. Clin Microbiol Rev 30: 1015-1063. https://doi.org/10.1128/cmr.00016-17
|
| [26] | Sewe SO, Silva G, Sicat P, et al. (2022) Trimming and validation of Illumina short reads using trimmomatic, trinity assembly, and assessment of RNA-Seq data. Plant Bioinformatics. Methods in Molecular Biology : 211-232. https://doi.org/10.1007/978-1-0716-2067-0_11 |
| [27] |
Wood DE, Lu J, Langmead B (2019) Improved metagenomic analysis with Kraken 2. Genome Biol 20: 257. https://doi.org/10.1186/s13059-019-1891-0
|
| [28] |
Liang H, Zou Y, Wang M, et al. (2025) Efficiently constructing complete genomes with CycloneSEQ to fill gaps in bacterial draft assemblies. GigaByte 2025: gigabyte154-0. https://doi.org/10.46471/gigabyte.154
|
| [29] | Faruk MO, Sarkar MMH, Hossain MDI, et al. (2024) Genomic characterization and functional insights of multidrug-resistant Klebsiella pneumoniae strain BCSIR-JUMIID. bioRxiv . https://doi.org/10.1101/2024.11.27.625610 |
| [30] |
Sayem M, Rafi MA, Mishu ID, et al. (2025) Comprehensive genomic analysis reveals virulence and antibiotic resistance genes in a multidrug-resistant Bacillus cereus isolated from hospital wastewater in Bangladesh. Sci Rep 15: 22915. https://doi.org/10.1038/s41598-025-06655-w
|
| [31] |
Azra, Khan TA, Ul Haq I, et al. (2025) Antibiotic susceptibility patterns and virulence profiles of classical and hypervirulent Klebsiella pneumoniae strains isolated from clinical samples in Khyber Pakhtunkhwa, Pakistan. Pathogens 14: 79. https://doi.org/10.3390/pathogens14010079
|
| [32] |
Sah RSP, Dhungel B, Yadav BK, et al. (2021) Detection of TEM and CTX-M genes in Escherichia coli isolated from clinical specimens at tertiary care heart hospital, Kathmandu, Nepal. Diseases 9: 15. https://doi.org/10.3390/diseases9010015
|
| [33] | Bina M, Pournajaf A, Mirkalantari S, et al. (2015) Detection of the Klebsiella pneumoniae carbapenemase (KPC) in K. pneumoniae isolated from clinical samples by phenotypic and genotypic methods. Iran J Pathol 10: 199-205. |
| [34] |
Pérez-Vázquez M, Oteo-Iglesias J, Sola-Campoy PJ, et al. (2019) Characterization of carbapenemase-producing Klebsiella oxytoca in Spain, 2016–2017. Antimicrob Agents Chemother 63: e02529-18. https://doi.org/10.1128/AAC.02529-18
|
| [35] |
Kuinkel S, Acharya J, Dhungel B, et al. (2021) Biofilm formation and phenotypic detection of ESBL, MBL, KPC and AmpC enzymes and their coexistence in Klebsiella spp. isolated at the National Reference Laboratory, Kathmandu, Nepal. Microbiol Res 12: 683-697. https://doi.org/10.3390/microbiolres12030049
|
| [36] |
Nirwati H, Sinanjung K, Fahrunissa F, et al. (2019) Biofilm formation and antibiotic resistance of Klebsiella pneumoniae isolated from clinical samples in a tertiary care hospital, Klaten, Indonesia. BMC Proc 13: 20. https://doi.org/10.1186/s12919-019-0176-7
|
| [37] | Hassan NM, Dawood AB, Mohamed MM, et al. (2024) Distribution, characterization and antibiotic resistance of hypervirulent Klebsiella pneumoniae (hvKp) strains versus classical strains (CKp) causing healthcare-associated infections in Sohag University Hospitals. Microbes Infect Dis 5: 738-748. https://doi.org/10.21608/mid.2024.272832.1823 |
| [38] |
Moustafa NM, Mahmoud FM, Khamsin NWB, et al. (2023) Antimicrobial susceptibility of Klebsiella pneumoniae isolated from intensive and non-intensive care units patients: A one-year retrospective study in a tertiary healthcare hospital, Saudi Arabia. J Pure Appl Microbiol 17: 2453-2466. https://doi.org/10.22207/JPAM.17.4.43
|
| [39] |
Wani FA, Bandy A, Alenzi MJS, et al. (2021) Resistance patterns of gram-negative bacteria recovered from clinical specimens of intensive care patients. Microorganisms 9: 2246. https://doi.org/10.3390/microorganisms9112246
|
| [40] |
Ramirez MS, Tolmasky ME (2017) Amikacin: Uses, resistance, and prospects for inhibition. Molecules 22: 2267. https://doi.org/10.3390/molecules22122267
|
| [41] |
Kazmierczak KM, Karlowsky JA, de Jonge BLM, et al. (2021) Epidemiology of carbapenem resistance determinants identified in meropenem-nonsusceptible Enterobacterales collected as part of a global surveillance program, 2012 to 2017. Antimicrob Agents Chemother 65: e02000-20. https://doi.org/10.1128/aac.02000-20
|
| [42] |
Sader HS, Mendes RE, Streit JM, et al. (2022) Antimicrobial susceptibility of gram-negative bacteria from intensive care unit and non-intensive care unit patients from United States hospitals (2018–2020). Diagn Microbiol Infect Dis 102: 115557. https://doi.org/10.1016/j.diagmicrobio.2021.115557
|
| [43] |
Silvester R, Madhavan A, Kokkat A, et al. (2022) Global surveillance of antimicrobial resistance and hypervirulence in Klebsiella pneumoniae from LMICs: An in-silico approach. Sci Total Environ 802: 149859. https://doi.org/10.1016/j.scitotenv.2021.149859
|
| [44] |
Dalhoff A (2012) Global fluoroquinolone resistance epidemiology and implications for clinical use. Interdiscip Perspect Infect Dis 2012: 976273. https://doi.org/10.1155/2012/976273
|
| [45] |
Munoz-Davila MJ (2014) Role of old antibiotics in the era of antibiotic resistance: Highlighting nitrofurantoin for the treatment of lower urinary tract infections. Antibiotics 3: 39-48. https://doi.org/10.3390/antibiotics3010039
|
| [46] |
Xiao S, Chen T, Wang H, et al. (2021) Drug susceptibility and molecular epidemiology of Klebsiella pneumoniae bloodstream infection in ICU patients in Shanghai, China. Front Med 8: 754944. https://doi.org/10.3389/fmed.2021.754944
|
| [47] |
Bassetti M, Vena A, Sepulcri C, et al. (2020) Treatment of bloodstream infections due to gram-negative bacteria with difficult-to-treat resistance. Antibiotics 9: 632. https://doi.org/10.3390/antibiotics9090632
|
| [48] |
Mohd Asri NA, Ahmad S, Mohamud R, et al. (2021) Global prevalence of nosocomial multidrug-resistant Klebsiella pneumoniae: A systematic review and meta-analysis. Antibiotics 10: 1508. https://doi.org/10.3390/antibiotics10121508
|
| [49] |
Nakamura-Silva R, Cerdeira L, Oliveira-Silva M, et al. (2022) Multidrug-resistant Klebsiella pneumoniae: A retrospective study in Manaus, Brazil. Arch Microbiol 204: 202. https://doi.org/10.1007/s00203-022-02813-0
|
| [50] |
Abbott IJ, Peel TN, Cairns KA, et al. (2023) Antibiotic management of urinary tract infections in the post-antibiotic era: A narrative review highlighting diagnostic and antimicrobial stewardship. Clin Microbiol Infect 29: 1254-1266. https://doi.org/10.1016/j.cmi.2022.05.016
|
| [51] |
Kot B, Piechota M, Szweda P, et al. (2023) Virulence analysis and antibiotic resistance of Klebsiella pneumoniae isolates from hospitalised patients in Poland. Sci Rep 13: 4448. https://doi.org/10.1038/s41598-023-31086-w
|
| [52] |
Alharbi MT, Almuhayawi MS, Nagshabandi MK, et al. (2023) Antimicrobial resistance pattern, pathogenicity and molecular properties of hypervirulent Klebsiella pneumoniae (hvKp) among hospital-acquired infections in the intensive care unit (ICU). Microorganisms 11: 661. https://doi.org/10.3390/microorganisms11030661
|
| [53] | Ali F (2024) Investigation of the resistance of Klebsiella bacteria to antibiotics and the synthesis of virulence factors isolated from various pathogenic infections. J La Lifesci 5: 307-322. https://doi.org/10.37899/journallalifesci.v5i4.1245 |
| [54] | Ali H, Jabir DM, Falih Z, et al. (2025) Phenotypic and genotypic analysis of hypermucoviscous Klebsiella pneumoniae (hmKp) strain. Iran J Microbiol 17: 734-740. https://doi.org/10.18502/ijm.v17i5.19882 |
| [55] |
Arcari G, Carattoli A (2023) Global spread and evolutionary convergence of multidrug-resistant and hypervirulent Klebsiella pneumoniae high-risk clones. Pathog Glob Health 117: 328-341. https://doi.org/10.1080/20477724.2022.2121362
|
| [56] |
Elias R, Phelan JE, Lito L, et al. (2025) Genome-wide analysis and longitudinal study of Klebsiella pneumoniae in Portugal: Tracing the evolution and spread of carbapenem resistance. Int J Antimicrob Agents 66: 107583. https://doi.org/10.1016/j.ijantimicag.2025.107583
|
| [57] |
Al Fadhli AH, Mouftah SF, Jamal WY, et al. (2023) Cracking the code: Unveiling the diversity of carbapenem-resistant Klebsiella pneumoniae clones in the Arabian Peninsula through genomic surveillance. Antibiotics 12: 1081. https://doi.org/10.3390/antibiotics12071081
|
| [58] |
Di Pilato V, De Angelis LH, Aiezza N, et al. (2022) Resistome and virulome accretion in an NDM-1-producing ST147 sublineage of Klebsiella pneumoniae associated with an outbreak in Tuscany, Italy: A genotypic and phenotypic characterisation. Lancet Microbe 3: e224-e234. https://doi.org/10.1016/S2666-5247(21)00268-8
|
| [59] |
Alam M, Saleem Z, Haseeb A, et al. (2023) Tackling antimicrobial resistance in primary care facilities across Pakistan: Current challenges and implications for the future. J Infect Public Health 16: 97-110. https://doi.org/10.1016/j.jiph.2023.10.046
|
| [60] |
Maveke SM, Aboge GO, Kanja LW, et al. (2024) Phenotypic and genotypic characterization of extended spectrum beta-lactamase-producing clinical isolates of Escherichia coli and Klebsiella pneumoniae in two Kenyan facilities: A national referral and a level five hospital. Int J Microbiol 2024: 7463899. https://doi.org/10.1155/2024/7463899
|
| [61] |
Nossair MA, Abd El Baqy FA, Rizk MSY, et al. (2022) Prevalence and molecular characterization of extended-spectrum β-lactamases and AmpC β-lactamase-producing Enterobacteriaceae among human, cattle, and poultry. Pathogens 11: 852. https://doi.org/10.3390/pathogens11080852
|
| [62] |
Shawa M, Chambaro H, Kamboyi HK, et al. (2025) In silico characterization of chromosomally integrated blaCTX-M genes among clinical Enterobacteriaceae in Africa: Insights from whole-genome analysis. Front Microbiol 16: 1655907. https://doi.org/10.3389/fmicb.2025.1655907
|
| [63] |
Mitra S, Naha S, Chakraborty J, et al. (2025) Diversity of mobile genetic elements in carbapenem-resistant Enterobacterales isolated from the intensive care units of a tertiary care hospital in Northeast India. Front Microbiol 16: 1543427. https://doi.org/10.3389/fmicb.2025.1543427
|
| [64] |
Gomaa Elsayed A, M Fahmy E, Abdellatif Alsayed M, et al. (2024) Study of plasmid-mediated quinolone resistance genes among Escherichia coli and Klebsiella pneumoniae isolated from pediatric patients with sepsis. Sci Rep 14: 11849. https://doi.org/10.1038/s41598-024-61357-z
|
| [65] |
Vieira DC, Lima WG, de Paiva MC (2020) Plasmid-mediated quinolone resistance (PMQR) among Enterobacteriales in Latin America: A systematic review. Mol Biol Rep 47: 1471-1483. https://doi.org/10.1007/s11033-019-05220-9
|
| [66] |
Ahmed OB, Asghar AH, Bamaga M, et al. (2023) Characterization of aminoglycoside resistance genes in multidrug-resistant Klebsiella pneumoniae collected from tertiary hospitals during the COVID-19 pandemic. PLoS One 18: e0289359. https://doi.org/10.1371/journal.pone.0289359
|
| [67] |
Zhang X, Li Q, Lin H, et al. (2021) High-level aminoglycoside resistance in human clinical Klebsiella pneumoniae complex isolates and characteristics of armA-carrying IncHI5 plasmids. Front Microbiol 12: 636396. https://doi.org/10.3389/fmicb.2021.636396
|
| [68] |
Wyres KL, Lam MMC, Holt KE (2020) Population genomics of Klebsiella pneumoniae. Nat Rev Microbiol 18: 344-359. https://doi.org/10.1038/s41579-019-0315-1
|
 microbiol-12-03-027-s001.pdf |
 |
Figures(6) / Tables(1)
Aiman Waheed, Sumera Afzal Khan, Taj Ali Khan, Sajjad Ahmad, Aakash Ahmad Khattak, Taane G. Clark, Nigel G. Ternan, Fahad Ahmed, Ibrahim M. Banat, Zahoor Khan. Genomic epidemiology of multidrug-resistant Klebsiella pneumoniae reveals lineage-specific resistance patterns with limited virulence determinants[J]. AIMS Microbiology, 2026, 12(3): 610-631. doi: 10.3934/microbiol.2026027
DownLoad: