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Background Carbapenem-resistant hypervirulent  K. pneumoniae  (CR-hvKP) causes serious infections with significant morbidity and mortality. However, the epidemiology and transmission mechanisms of CR-hvKP and the corresponding carbapenem-resistant plasmids require further investigation. Herein, we have characterized an ST11  K. pneumoniae  strain EBSI041 from the blood sample encoding both hypervirulence and carbapenem resistance phenotypes from a patient in Egypt. Results K. pneumoniae  strain EBSI041 showed multidrug-resistance phenotypes, where it was highly resistant to almost all tested antibiotics including carbapenems. And hypervirulence phenotypes of EBSI041 was confirmed by the model of  Galleria mellonella  infection. Whole-genome sequencing analysis showed that the hybrid plasmid pEBSI041-1 carried a set of virulence factors  rmpA ,  rmpA2 ,  iucABCD  and  iutA , and six resistance genes  aph(3′)-VI ,  armA ,  msr(E) ,  mph(E), qnrS , and  sul2 . Besides,  bla  OXA-48  and  bla  SHV-12  were harboured in a novel conjugative IncL-type plasmid pEBSI041-2. The  bla  KPC-2 -carrying plasmid pEBSI041-3, a non-conjugative plasmid lacking the conjugative transfer genes, could be transferred with the help of pEBSI041-2, and the two plasmids could fuse into a new plasmid during co-transfer. Moreover, the emergence of the p16HN-263_KPC-like plasmids is likely due to the integration of pEBSI041-3 and pEBSI041-4 via IS 26 -mediated rearrangement. Conclusion To the best of our knowledge, this is the first report on the complete genome sequence of KPC-2- and OXA-48-coproducing hypervirulent  K. pneumoniae  from Egypt. These results give new insights into the adaptation and evolution of  K. pneumoniae  during nosocomial infections.

Carriage of distinct blaKPC-2 and blaOXA-48 plasmids in a single ST11 hypervirulent Klebsiella pneumoniae isolate in Egypt