Detection of morphological variants of colistin-resistant Klebsiella pneumoniae associated with sepsis in Kerala, India.

Infections caused by colistin resistant Klebsiella pneumoniae are a major global health challenge linked to high mortality rates worldwide. Increased incidence of hypervirulent and drug-resistant Klebsiella causing life-threatening infections in young healthy individuals and asymptomatic carriage in the community has been largely reported in the Asian-Pacific Rim. This study conducted a molecular analysis of two morphologically distinct variants of K. pneumoniae that caused bacteremia and sepsis in a patient. Colony morphology of the isolates was characterized in various growth media, and the morphological variants differed in their mucoviscosity. The isolates were found to be serotype K2 (highly associated with hypervirulent Klebsiella) by molecular serotyping using specific PCR primers. The multidrug-resistant nature of the colony variants was evaluated by antibiotic susceptibility testing and it was found to have a similar antibiogram pattern in in vitro. An increased minimum inhibitory concentration (MIC) of colistin (>64 μg mL-1) was detected in both isolates using broth microdilution, and they were found to be highly resistant to colistin. Molecular analysis revealed that the isolates possessed a chromosomal mutation in mgrB, which causes colistin resistance. The increased incidence of infection caused by colistin-resistant K. pneumoniae requires continuous monitoring, and appropriate measures are necessary to control its adaptive evolution in healthcare settings.