Intestinal colonisation with hypervirulent or third-generation cephalosporin-resistant Klebsiella pneumoniae strains upon hospital admission in a general ward in Taiwan.

We aimed to investigate the clinical characteristics of patients with hypervirulent and/or third-generation cephalosporin-resistant (3GCR) Klebsiella pneumoniae intestinal colonisation upon admission to a general ward at Taipei Veterans General Hospital in Taiwan in 2017. Stool surveillance cultures were obtained from patients and the clinical characteristics of the patients were studied retrospectively. Klebsiella pneumoniae strains were characterised for antimicrobial susceptibility, mechanisms of the 3GCR phenotype, and the presence of rmpA/A2 genes, which are markers of hypervirulent strains. Whole-genome sequencing was used to identify the relationship between the colonising strain and subsequent infection strain. Of the 408 patients admitted to the general ward, 87 patients with K. pneumoniae intestinal colonisation were identified. Of the 87 colonised patients, 28 (32.2%) and 9 (10.3%) carried 3GCR and hypervirulent K. pneumoniae strains, respectively. Stay in a long-term care facility and diabetes mellitus were more common in patients colonised with 3GCR strains than those with hypervirulent strains. The 28-day mortality rate was similar between the two groups. Major resistance mechanisms among the 3GCR strains involved the presence of extended-spectrum β-lactamase (ESBL) genes (67.9%) and blaDHA-1 (64.3%). One patient colonised with K. pneumoniae developed subsequent bacteraemia caused by the same strain. In conclusion, 3GCR strains were more common than hypervirulent strains in colonised patients, but clinical outcomes were similar. Future studies to elucidate risk factors for intestinal carriage of hypervirulent and 3GCR K. pneumoniae strains are needed for early identification and better management of these patients.