DOI: 10.1128/aac.00384-26 ISSN: 0066-4804
Identification of a hypervirulent extensively drug-resistant ST383
Klebsiella pneumoniae
sub-lineage carrying ICEKp5 in Lebanon
Martine Abboud, Tia Clara Chaaya, Yara Daccache, Nour El Alam, Theresa Gerges, Lea Haddad, Leon Kassabian, Jame Tannous, Yara Ghanem, Judy Nabbout, Kevin Chaar, Toni Nmeir, Anthony Haddad, Charbel Al Khoury, George F. Araj, Sima Tokajian ABSTRACT
Klebsiella pneumoniae
ST383 has emerged as a high-risk clone, characterized by carbapenem resistance and increasing detection of hypervirulence determinants. We describe a phylogenetically distinct ST383 sub-lineage in Lebanon, defined by the acquisition of ICEKp5, which carries the yersiniabactin locus. Three ST383
K. pneumoniae
clinical isolates (LBN_CAKp91, LBN_CTKp3, and LBN_CTKp11) recovered from a Lebanese medical center were subjected to whole-genome sequencing. Comparative genomic analysis included regional ST383 strains and previously characterized Lebanese isolates. The study isolates formed a tight, monophyletic cluster (three to nine single-nucleotide polymorphisms [SNPs]) that is phylogenetically distinct from the previously reported Lebanese ST383 clone (>164 SNPs) and grouped most closely to an Egyptian ST383 strain (59–65 SNPs). All three isolates carried ICEKp5 with yersiniabactin lineage
ybt14
, a feature absent in the earlier Lebanese ST383 clone. The isolates were the only ST383 strains to harbor the full spectrum of hypervirulence determinants to date, including capsule regulators (
rmpA
and
rmpA2
), aerobactin (
iucABCD
and
iutA
), yersiniabactin, and the hypervirulence biomarker
peg-344
. All isolates carried dual carbapenemases (
bla
OXA-48
and
bla
NDM-5
) in addition to
bla
CTX-M-15
and
bla
CTX-M-14b
. The genetic environments of
bla
OXA-48
and
bla
NDM-5
were highly conserved across geographically diverse ST383 isolates, indicating common plasmid origins. This study describes a phylogenetically distinct hypervirulent extensively drug-resistant (XDR) ST383
K. pneumoniae
sub-lineage in Lebanon. The acquisition of ICEKp5, combined with plasmid-borne hypervirulence and resistance determinants, reveals the concerning convergence of hypervirulence and XDR. Enhanced surveillance and infection control measures are urgently needed to monitor this emerging high-risk clone.