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Abstract：
UNASSIGNED: The \"hypervirulent\" variant of Klebsiella pneumoniae (hvKp) is an emerging pathogen that cause life-threatening infection. The present study was conducted to identify the prevalence of hvKp and to investigate the presence class 1, 2, and 3 integrons in these isolates.
UNASSIGNED: A cross-sectional study was conducted at three teaching hospitals, Ahvaz, South-west of Iran, from January 1, 2019 to December 31, 2020. Samples were collected from inpatients and included only the first samples collected from each patient. K. pneumoniae strains were isolated from different specimens using biochemical test and confirmed by targeting 16S-23S rDNA internal transcribed spacer. HvKp isolates were recovered using string test and were further characterized by detection virulence-associated genes (rmpA, iucA, and magA). Antibiotic susceptibility patterns of isolates were determined using the disc diffusion method. Isolates were screened for presence the integron genes (intI, intII, and intIII) and repetitive element sequence-based polymerase chain reaction (PCR) performed to determine strain relatedness. SPSS version 22 was used for the data analysis.
UNASSIGNED: Seventy-one (77%) of isolates showed multidrug-resistant (MDR) phenotype. HvKP accounted for 14% (13/92) of cKp isolated from blood (46%) and urinary tract infection (38%), and the great majority of them (61.5%; 8/13) exhibited MDR phenotype. Using the PCR assay, 29 of 92 isolates (31.5%) were found to have positive results for the presence of IntI. Three of the IntI-positive strains were hvKP. Class 2 integron was present in 8/92 cKp isolates. Integron Class 2 was found to coexist with Class 1 integron in 3/8 isolates. All integron-positive isolates (IntI and/or IntII) were resistant to at least three different classes of antibiotics and showed MDR phenotype. No Class 3 integrons were detected among the isolates.
UNASSIGNED: The results of our study revealed that considering the role of integrons in facilitating the acquisition and dissemination of resistance genes among bacteria, monitoring the emergence of hvKp, emphasizing on the mechanism of antimicrobial resistance, can prevent from the spread of carbapenemase-producing hvKp strains.
UNASSIGNED: A cross-sectional study was conducted at three teaching hospitals, Ahvaz, South-west of Iran, from January 1, 2019 to December 31, 2020. Samples were collected from inpatients and included only the first samples collected from each patient. K. pneumoniae strains were isolated from different specimens using biochemical test and confirmed by targeting 16S-23S rDNA internal transcribed spacer. HvKp isolates were recovered using string test and were further characterized by detection virulence-associated genes (rmpA, iucA, and magA). Antibiotic susceptibility patterns of isolates were determined using the disc diffusion method. Isolates were screened for presence the integron genes (intI, intII, and intIII) and repetitive element sequence-based polymerase chain reaction (PCR) performed to determine strain relatedness. SPSS version 22 was used for the data analysis.
UNASSIGNED: Seventy-one (77%) of isolates showed multidrug-resistant (MDR) phenotype. HvKP accounted for 14% (13/92) of cKp isolated from blood (46%) and urinary tract infection (38%), and the great majority of them (61.5%; 8/13) exhibited MDR phenotype. Using the PCR assay, 29 of 92 isolates (31.5%) were found to have positive results for the presence of IntI. Three of the IntI-positive strains were hvKP. Class 2 integron was present in 8/92 cKp isolates. Integron Class 2 was found to coexist with Class 1 integron in 3/8 isolates. All integron-positive isolates (IntI and/or IntII) were resistant to at least three different classes of antibiotics and showed MDR phenotype. No Class 3 integrons were detected among the isolates.
UNASSIGNED: The results of our study revealed that considering the role of integrons in facilitating the acquisition and dissemination of resistance genes among bacteria, monitoring the emergence of hvKp, emphasizing on the mechanism of antimicrobial resistance, can prevent from the spread of carbapenemase-producing hvKp strains.
摘要：
■肺炎克雷伯菌（hvKp）的“高毒力”变种是一种新兴的病原体，可引起危及生命的感染。进行本研究以确定hvKp的患病率并调查这些分离物中1、2和3类整合子的存在。
■在三家教学医院进行了一项横断面研究，Ahvaz,伊朗西南部,从2019年1月1日至2020年12月31日。从住院患者收集样品,并且仅包括从每个患者收集的第一样品。使用生化测试从不同标本中分离肺炎克雷伯菌菌株，并通过靶向16S-23SrDNA内部转录间隔区进行确认。使用字符串测试回收HvKp分离株，并通过检测毒力相关基因（rmpA，iuca,和magA）。使用圆盘扩散法确定分离株的抗生素敏感性模式。筛选分离株是否存在整合子基因(intI，intII,和intIII）和基于重复元件序列的聚合酶链反应（PCR）来确定菌株相关性。采用SPSS版本22进行数据分析。
■七十一（77％）的分离株显示多药耐药（MDR）表型。HvKP占血液分离的cKp（46％）和尿路感染（38％）的14％（13/92），其中绝大多数（61.5%；8/13）表现为MDR表型。使用PCR检测，发现92个分离株中的29个(31.5%)对IntI的存在具有阳性结果。IntI阳性菌株中的三个是hvKP。2类整合子存在于8/92cKp分离株中。在3/8个分离株中发现2类整合子与1类整合子共存。所有整合子阳性分离株（IntI和/或IntII）对至少三种不同类型的抗生素具有抗性，并显示MDR表型。在分离物中没有检测到3类整合子。
■我们的研究结果表明，考虑到整合子在促进细菌中抗性基因的获取和传播中的作用，监测hvKp的出现，强调抗菌素耐药性的机制，可以防止产生碳青霉烯酶的hvKp菌株的传播。
■在三家教学医院进行了一项横断面研究，Ahvaz,伊朗西南部,从2019年1月1日至2020年12月31日。从住院患者收集样品,并且仅包括从每个患者收集的第一样品。使用生化测试从不同标本中分离肺炎克雷伯菌菌株，并通过靶向16S-23SrDNA内部转录间隔区进行确认。使用字符串测试回收HvKp分离株，并通过检测毒力相关基因（rmpA，iuca,和magA）。使用圆盘扩散法确定分离株的抗生素敏感性模式。筛选分离株是否存在整合子基因(intI，intII,和intIII）和基于重复元件序列的聚合酶链反应（PCR）来确定菌株相关性。采用SPSS版本22进行数据分析。
■七十一（77％）的分离株显示多药耐药（MDR）表型。HvKP占血液分离的cKp（46％）和尿路感染（38％）的14％（13/92），其中绝大多数（61.5%；8/13）表现为MDR表型。使用PCR检测，发现92个分离株中的29个(31.5%)对IntI的存在具有阳性结果。IntI阳性菌株中的三个是hvKP。2类整合子存在于8/92cKp分离株中。在3/8个分离株中发现2类整合子与1类整合子共存。所有整合子阳性分离株（IntI和/或IntII）对至少三种不同类型的抗生素具有抗性，并显示MDR表型。在分离物中没有检测到3类整合子。
■我们的研究结果表明，考虑到整合子在促进细菌中抗性基因的获取和传播中的作用，监测hvKp的出现，强调抗菌素耐药性的机制，可以防止产生碳青霉烯酶的hvKp菌株的传播。
