{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T10:38:26Z","timestamp":1791887906723,"version":"4.3.4"},"reference-count":43,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T00:00:00Z","timestamp":1699488000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"United States Armed Forces Health Surveillance Division (AFHSD) Global Emerging Infections Surveillance (GEIS)","award":["P0119_18_KY_013"],"award-info":[{"award-number":["P0119_18_KY_013"]}]},{"name":"United States Armed Forces Health Surveillance Division (AFHSD) Global Emerging Infections Surveillance (GEIS)","award":["P152_20_KY_06"],"award-info":[{"award-number":["P152_20_KY_06"]}]},{"name":"United States Armed Forces Health Surveillance Division (AFHSD) Global Emerging Infections Surveillance (GEIS)","award":["P0065_21_KY"],"award-info":[{"award-number":["P0065_21_KY"]}]},{"name":"United States Armed Forces Health Surveillance Division (AFHSD) Global Emerging Infections Surveillance (GEIS)","award":["P0037_22_KY"],"award-info":[{"award-number":["P0037_22_KY"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Klebsiella pneumoniae is a threat to public health due to its continued evolution. In this study, we investigated the evolution, convergence, and transmission of hypervirulent and multi-drug resistant (MDR) clones of K. pneumoniae within healthcare facilities in Uganda. There was high resistance to piperacillin (90.91%), cefuroxime (86.96%), ceftazidime (84.62%), cefotaxime (84.00%), amoxicillin\/clavulanate (75%), nalidixic acid (73.68%), and nitrofurantoin (71.43%) antibiotics among K. pneumoniae isolates. The isolates were genetically diverse, consisting of 20 different sequence types (STs) and 34 K-serotype groups. Chromosomal fosA (for fosfomycin) and oqxAB efflux pump genes were detected in all isolates. Two carbapenem resistance genes, blaNDM-5 and blaOXA-181 plus extended-spectrum beta-lactamase (blaCTX-M-15) gene (68.12%), quinolone-resistant genes qnrS1 (28.99%), qnrB1 (13.04%), and qnrB6 (13.04%) and others were found. All, except three of the isolates, harbored plasmids. While the isolates carried a repertoire of virulence genes, only two isolates carried hypervirulent genes demonstrating a low prevalence (2.90%) of hypervirulent strains. Our study demonstrated genetically diverse populations of K. pneumoniae, low levels of carbapenem resistance among the isolates, and no convergence of MDR and hypervirulence. Emerging high-risk international pandemic clones (ST11, ST14, ST147, ST 86 and ST307) were detected in these healthcare settings which are difficult to treat.<\/jats:p>","DOI":"10.3390\/pathogens12111334","type":"journal-article","created":{"date-parts":[[2023,11,9]],"date-time":"2023-11-09T08:08:58Z","timestamp":1699517338000},"page":"1334","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Genome Analysis of Klebsiella pneumoniae Reveals International High-Risk Pandemic MDR Clones Emerging in Tertiary Healthcare Settings in Uganda"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4175-5659","authenticated-orcid":false,"given":"Denis K.","family":"Byarugaba","sequence":"first","affiliation":[{"name":"Makerere University Walter Reed Project, Kampala P.O. Box 16524, Uganda"},{"name":"College of Veterinary Medicine, Makerere University, Kampala P.O. Box 7062, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bernard","family":"Erima","sequence":"additional","affiliation":[{"name":"Makerere University Walter Reed Project, Kampala P.O. Box 16524, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8079-3474","authenticated-orcid":false,"given":"Godfrey","family":"Wokorach","sequence":"additional","affiliation":[{"name":"Makerere University Walter Reed Project, Kampala P.O. Box 16524, Uganda"},{"name":"Multifunctional Research Laboratories, Gulu University, Gulu P.O. Box 166, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen","family":"Alafi","sequence":"additional","affiliation":[{"name":"Makerere University Walter Reed Project, Kampala P.O. Box 16524, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannah","family":"Kibuuka","sequence":"additional","affiliation":[{"name":"Makerere University Walter Reed Project, Kampala P.O. Box 16524, Uganda"},{"name":"College of Veterinary Medicine, Makerere University, Kampala P.O. Box 7062, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edison","family":"Mworozi","sequence":"additional","affiliation":[{"name":"Makerere University Walter Reed Project, Kampala P.O. Box 16524, Uganda"},{"name":"College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Najjuka","sequence":"additional","affiliation":[{"name":"College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Kiyengo","sequence":"additional","affiliation":[{"name":"Uganda Peoples\u2019 Defence Forces, Ministry of Defence, Kampala P.O. Box 3798, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ambrose K.","family":"Musinguzi","sequence":"additional","affiliation":[{"name":"Uganda Peoples\u2019 Defence Forces, Ministry of Defence, Kampala P.O. Box 3798, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fred","family":"Wabwire-Mangen","sequence":"additional","affiliation":[{"name":"Makerere University Walter Reed Project, Kampala P.O. Box 16524, Uganda"},{"name":"College of Health Sciences, Makerere University, Kampala P.O. Box 7062, Uganda"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"E3574","DOI":"10.1073\/pnas.1501049112","article-title":"Genomic analysis of diversity, population structure, virulence, and antimicrobial resistance in Klebsiella pneumoniae, an urgent threat to public health","volume":"112","author":"Holt","year":"2015","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"184","DOI":"10.5001\/omj.2019.37","article-title":"WHO global priority pathogens list: A bibliometric analysis of medline-pubmed for knowledge mobilization to infection prevention and control practices in Bahrain","volume":"34","author":"Asokan","year":"2019","journal-title":"Oman Med. 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