{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T13:49:06Z","timestamp":1793022546700,"version":"4.5.0"},"reference-count":37,"publisher":"SAGE Publications","issue":"12","license":[{"start":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T00:00:00Z","timestamp":1784160000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2026,12,1]]},"abstract":"\n Background:<\/jats:title>\n \n Klebsiella pneumoniae<\/jats:italic>\n is a major etiological agent of pediatric sepsis. The emergence and dissemination of carbapenem-resistant\n K. pneumoniae<\/jats:italic>\n (CRKP) and hypervirulent strains (hvKp) represent an escalating global health concern. However, data regarding the coexistence of carbapenem resistance and hypervirulence in pediatric populations, especially in low- and middle-income countries, remain limited.\n <\/jats:p>\n <\/jats:sec>\n \n Objectives:<\/jats:title>\n \n This study aimed to determine the prevalence of carbapenem resistance and hypervirulence-associated genes among pediatric\n K. pneumoniae<\/jats:italic>\n bloodstream infections in Egypt and to assess their association.\n <\/jats:p>\n <\/jats:sec>\n \n Methods:<\/jats:title>\n \n A cross-sectional study was conducted involving 100 pediatric patients with culture-confirmed\n K. pneumoniae<\/jats:italic>\n sepsis at Mansoura University Children\u2019s Hospital between January 2023 and January 2025. Clinical and laboratory data were collected. Antimicrobial susceptibility testing was performed using standard disc diffusion and carbapenemase inhibition assays. Polymerase chain reaction (PCR) was employed to detect carbapenemase genes (including blaNDM for New Delhi metallo-\u03b2-lactamase, blaOXA-48 for oxacillinase-48, blaKPC for\n K. pneumoniae<\/jats:italic>\n carbapenemase, blaVIM for Verona integron-encoded metallo-\u03b2-lactamase, and blaIMP for imipenemase). Hypervirulence genes tested included iucA (aerobactin siderophore synthesis), iroN and iroB (salmochelin siderophore cluster), and peg-344 (putative transporter). Genotypic hvKp was defined as the presence of two or more hypervirulence-associated genes.\n <\/jats:p>\n <\/jats:sec>\n \n Results:<\/jats:title>\n \n Carbapenem resistance was identified in 64% of isolates, with\n blaNDM<\/jats:italic>\n (New Delhi metallo-\u03b2-lactamase) and blaOXA-48-like (oxacillinase-48) genes being the most prevalent carbapenemase determinants. Hypervirulence-associated genes were detected in 86% of isolates, which were classified as genotypic hvKp, most frequently\n iucA<\/jats:italic>\n (aerobactin system) and peg-344 (putative transporter). No significant demographic or inflammatory differences were observed between CRKP and carbapenem-susceptible groups. Hypervirulence was present at similarly high frequencies in CRKP (87%) and carbapenem-susceptible\n K. pneumoniae<\/jats:italic>\n (84%) isolates, with no significant association between these traits (\n p<\/jats:italic>\n = 0.782). Logistic regression analysis did not identify any clinical predictors of hypervirulent infection.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n \n The detection of multidrug-resistant\n K. pneumoniae<\/jats:italic>\n isolates harboring multiple hypervirulence-associated genes highlights the potential convergence of resistance and virulence determinants. However, further phenotypic and functional studies are required to confirm the hypervirulent phenotype and assess its clinical significance.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/10766294261467808","type":"journal-article","created":{"date-parts":[[2026,7,16]],"date-time":"2026-07-16T10:45:38Z","timestamp":1784198738000},"page":"552-559","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Carbapenem Resistance and Hypervirulence in Pediatric\n Klebsiella pneumoniae<\/i>\n Sepsis"],"prefix":"10.1177","volume":"32","author":[{"given":"Dina","family":"Mohammed Abdel-Hady","sequence":"first","affiliation":[{"name":"Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Ahmed Noureldin","sequence":"additional","affiliation":[{"name":"Pediatrics Department, Faculty of Medicine, Horus University, Damietta, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5431-0248","authenticated-orcid":false,"given":"Maysaa","family":"El Sayed Zaki","sequence":"additional","affiliation":[{"name":"Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eman H.M.","family":"Salem","sequence":"additional","affiliation":[{"name":"Medical Microbiology and Immunology Department, Faculty of Medicine, Menoufia University, Menoufia, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karim","family":"Abdelfattah Montasser","sequence":"additional","affiliation":[{"name":"Clinical Pathology Department, Faculty of Medicine, Helwan University, Helwan, Egypt."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,16]]},"reference":[{"key":"e_1_3_3_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2024.0179"},{"key":"e_1_3_3_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-019-03761-2"},{"key":"e_1_3_3_4_1","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.01375"},{"key":"e_1_3_3_5_1","first-page":"106144","article-title":"The emerging threat of carbapenemase-producing Klebsiella","volume":"56","author":"Zowawi HM","year":"2020","unstructured":"4.Zowawi HM, , Harris PN, , Roberts MJ, et al. The emerging threat of carbapenemase-producing Klebsiella. Int J Antimicrob Agents 2020;56:106144.","journal-title":"Int J Antimicrob Agents"},{"key":"e_1_3_3_6_1","first-page":"510","article-title":"Pediatric carbapenemase-producing Enterobacterales in Egypt","volume":"29","author":"Rabiee N","year":"2023","unstructured":"5.Rabiee N, , Hassan R, , El-Kholy A, et al. Pediatric carbapenemase-producing Enterobacterales in Egypt. Microb Drug Resist 2023;29:510\u2013518.","journal-title":"Microb Drug Resist"},{"key":"e_1_3_3_7_1","first-page":"335","article-title":"Pediatric cancer patients infected with carbapenem-resistant Klebsiella pneumoniae","volume":"14","author":"Mansour MT","year":"2021","unstructured":"6.Mansour MT, , Mahmoud NF, , Gomaa HE, et al. Pediatric cancer patients infected with carbapenem-resistant Klebsiella pneumoniae. Infect Drug Resist 2021;14:335\u2013348.","journal-title":"Infect Drug Resist"},{"key":"e_1_3_3_8_1","first-page":"113","article-title":"Emergence of carbapenem-resistant bacteria in Egypt","volume":"16","author":"Afify FA","year":"2024","unstructured":"7.Afify FA, , El Sherbiny GM, , Hassan R, et al. Emergence of carbapenem-resistant bacteria in Egypt. Infect Dis Rep 2024;16:113\u2013121.","journal-title":"Infect Dis Rep"},{"key":"e_1_3_3_9_1","first-page":"622","article-title":"Genomic markers of hypervirulent Klebsiella pneumoniae","volume":"16","author":"Lam MMC","year":"2018","unstructured":"8.Lam MMC, , Wyres KL, , Wick RR, et al. Genomic markers of hypervirulent Klebsiella pneumoniae. Nat Rev Microbiol 2018;16:622\u2013635.","journal-title":"Nat Rev Microbiol"},{"key":"e_1_3_3_10_1","first-page":"565","article-title":"Hypervirulent Klebsiella pneumoniae: Clinical and molecular perspectives","volume":"294","author":"Choby JE","year":"2023","unstructured":"9.Choby JE, , Howard-Anderson JR, , Weiss DS. Hypervirulent Klebsiella pneumoniae: Clinical and molecular perspectives. J Intern Med 2023;294:565\u2013582.","journal-title":"J Intern Med"},{"key":"e_1_3_3_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ebiom.2025.105627"},{"key":"e_1_3_3_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2025.1680292"},{"key":"e_1_3_3_13_1","first-page":"463","article-title":"Emergence and hospital dissemination of hypervirulent carbapenem-resistant Klebsiella pneumoniae: A genomic epidemiology study","volume":"25","author":"Zhou W","year":"2025","unstructured":"12.Zhou W, , Li X, , Huang C, et al. Emergence and hospital dissemination of hypervirulent carbapenem-resistant Klebsiella pneumoniae: A genomic epidemiology study. BMC Microbiol 2025;25:463.","journal-title":"BMC Microbiol"},{"key":"e_1_3_3_14_1","first-page":"16969","article-title":"Prevalence of hypervirulent Klebsiella pneumoniae and associated antimicrobial resistance patterns","volume":"15","author":"Najafian H","year":"2025","unstructured":"13.Najafian H, , Moradi M, , Ahmadi A, et al. Prevalence of hypervirulent Klebsiella pneumoniae and associated antimicrobial resistance patterns. Sci Rep 2025;15:16969.","journal-title":"Sci Rep"},{"key":"e_1_3_3_15_1","doi-asserted-by":"publisher","DOI":"10.1093\/jac\/dkp498"},{"issue":"9","key":"e_1_3_3_16_1","first-page":"e000196","article-title":"Genetic diversity and mobility of the yersiniabactin-encoding mobile element ICEKp in Klebsiella pneumoniae","volume":"4","author":"Lam MMC","year":"2018","unstructured":"15.Lam MMC, , Wick RR, , Wyres KL, et al. Genetic diversity and mobility of the yersiniabactin-encoding mobile element ICEKp in Klebsiella pneumoniae. Microb Genom. 2018;4(9):e000196.","journal-title":"Microb Genom."},{"key":"e_1_3_3_17_1","doi-asserted-by":"publisher","DOI":"10.4161\/viru.22718"},{"key":"e_1_3_3_18_1","first-page":"115","article-title":"Investigation of siderophore genes in hypervirulent Klebsiella pneumoniae isolates","volume":"19","author":"Nazari A","year":"2019","unstructured":"17.Nazari A, , Ghafourian S, , Sadeghifard N, et al. Investigation of siderophore genes in hypervirulent Klebsiella pneumoniae isolates. BMC Microbiol 2019;19:115.","journal-title":"BMC Microbiol"},{"key":"e_1_3_3_19_1","first-page":"2439","article-title":"Molecular characterization of virulence genes among Klebsiella pneumoniae isolates from Iranian patients","volume":"12","author":"Elhaki N","year":"2019","unstructured":"18.Elhaki N, , Azimi L, , Fallah F, et al. Molecular characterization of virulence genes among Klebsiella pneumoniae isolates from Iranian patients. Infect Drug Resist 2019;12:2439\u20132444.","journal-title":"Infect Drug Resist"},{"key":"e_1_3_3_20_1","doi-asserted-by":"publisher","DOI":"10.3390\/microorganisms12122469"},{"key":"e_1_3_3_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)02724-0"},{"key":"e_1_3_3_22_1","first-page":"19563","article-title":"Stepwise evolution of pandrug resistance in Klebsiella pneumoniae","volume":"10","author":"Zowawi HM","year":"2020","unstructured":"21.Zowawi HM, , Forde BM, , Alfaresi M, et al. Stepwise evolution of pandrug resistance in Klebsiella pneumoniae. Sci Rep 2020;10:19563.","journal-title":"Sci Rep"},{"key":"e_1_3_3_23_1","first-page":"345","article-title":"Epidemiology of carbapenem-resistant Enterobacterales in the Middle East","volume":"29","author":"Rabiee M","year":"2023","unstructured":"22.Rabiee M, , Saeedi M, , Ghalavand Z, et al. Epidemiology of carbapenem-resistant Enterobacterales in the Middle East. Microb Drug Resist 2023;29:345\u2013356.","journal-title":"Microb Drug Resist"},{"key":"e_1_3_3_24_1","first-page":"101","article-title":"High prevalence of carbapenem-resistant Klebsiella pneumoniae among Egyptian children","volume":"17","author":"Afify MM","year":"2024","unstructured":"23.Afify MM, , Khalifa HO, , Abdelfattah M, et al. High prevalence of carbapenem-resistant Klebsiella pneumoniae among Egyptian children. Infect Drug Resist 2024;17:101\u2013112.","journal-title":"Infect Drug Resist"},{"key":"e_1_3_3_25_1","first-page":"520","article-title":"Molecular profiling of carbapenem-resistant Enterobacterales in a pediatric ICU in Egypt","volume":"40","author":"Mansour M","year":"2021","unstructured":"24.Mansour M, , Ahmed S, , Abd El Hamid M, et al. Molecular profiling of carbapenem-resistant Enterobacterales in a pediatric ICU in Egypt. 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J Glob Antimicrob Resist 2020;22:51\u201356.","journal-title":"J Glob Antimicrob Resist"},{"key":"e_1_3_3_33_1","first-page":"104193","article-title":"Virulence determinants and carbapenem resistance in Klebsiella pneumoniae isolates from Egyptian hospitals","volume":"144","author":"Hassuna NA","year":"2020","unstructured":"32.Hassuna NA, , Abdelhadi AA, , Elkhatib WF. Virulence determinants and carbapenem resistance in Klebsiella pneumoniae isolates from Egyptian hospitals. Microb Pathog 2020;144:104193.","journal-title":"Microb Pathog"},{"key":"e_1_3_3_34_1","first-page":"561054","article-title":"Clinical severity predictors in hypervirulent Klebsiella pneumoniae infections","volume":"10","author":"Li J","year":"2020","unstructured":"33.Li J, , Ruan Z, , Fei Y, et al. Clinical severity predictors in hypervirulent Klebsiella pneumoniae infections. 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