Hypervirulent, dual-carbapenemase-producing Klebsiella pneumoniae isolated from a coal miner: A call for occupational AMR surveillance.

The emergence of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) threatens global health. We report the first occupational case of dual-site (sputum/stool) CR-hvKP colonization in a Chinese coal miner (no prior hospitalization). The ST11-KL64-O2α strain co-produced KPC-2/NDM-5 carbapenemases, exhibited hypermucoviscosity, and resisted all tested antibiotics except colistin.Genomic analysis confirmed the presence of the virulence gene rmpA2 and carbapenemase genes blaNDM-5and blaKPC-2 located on conjugative plasmids with distinct dissemination patterns: pKP16846_NDM (globally distributed) and pKP16846_KPC (restricted to the Asia-Pacific region). This case demonstrates the convergence of virulence and resistance in an industrial setting, suggesting that miners' gastrointestinal tracts may serve as underrecognized reservoirs of antimicrobial resistance. There is an urgent need to include occupational populations in AMR surveillance programs such as the WHO GLASS.