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Background  The nexus between resistance determinants, plasmid type, and clonality appears to play a crucial role in the dissemination and survival of carbapenem-resistant  Klebsiella pneumoniae  (CR KP ). The incidence of infections involving CR KP  in Saudi Arabia is increasing and there is a need for detailed molecular profiling of this pathogen for CR KP  surveillance and control.    Methods  The resistance determinants of 71 non-redundant CR KP  isolates were investigated by polymerase chain reaction (PCR) and sequencing. Plasmid typing was performed using PCR-based replicon typing and the clonality of isolates was determined by multilocus sequence typing. Capsular polysaccharide synthesis genes and other virulence factors were examined using multiplex PCR. Diversity was calculated using DIVEIN, clonal relationship was determined using eBURST, and phylogenetic analysis was performed using SplitsTree4.    Results  A polyclonal  OXA-48  gene alone was the most common carbapenemase detected in 48/71 (67.6%) isolates followed by  NDM-1  alone in 9/71 (12.7%) isolates. Coproduction of  OXA-48  and  NDM-1  was observed in 6/71 (8.5%) isolates. Both carbapenemase genes could be transferred into an  Escherichia coli  recipient.  CTX-M-15  was the most abundant extended-spectrum  β-lactamase  gene detected in 47/71 (66.2%) isolates, whereas clone-specific  CTX-M-14  (ST-199 and -709) was found in 15/71 (21%) isolates. Sixty-seven of 71 isolates were positive for one or more plasmid replicons. The replicons detected were: IncFII; IncFIIK; IncFIA; IncFIB; L/M; IncI1; and IncN. FIIK and L/M were predominant, with 69 and 67% positivity, respectively. All isolates were negative for the  magA  ( K1 ),  rmpA,  and  K2  genes and presented a non-hypermucoviscous phenotype.    Conclusion  A polyclonal CR KP  reservoir of sequence types (STs)-37, − 199, and − 152 was observed and ST-152 appeared to be a “frequent carrier” of the  NDM-1  gene. ST-199, a singleton not previously reported, showed a sequence diversity suggestive of positive selection. A significant association was evident between resistance determinants and the clonal types of  K. pneumoniae : all ST-152 isolates were positive for  NDM-1  but negative for  OXA-48 ; ST-199 isolates were positive for  OXA-48  but negative for  NDM-1 ; and ST-709 and -199 isolates were positive for  CTX-M-14 . The incidence of certain clonal types in large numbers predicts an outbreak-like situation and warrants stringent surveillance and infection control.    Electronic supplementary material  The online version of this article (10.1186/s12879-018-3114-9) contains supplementary material, which is available to authorized users.

bmc infectious diseases

Clonal diversity and genetic profiling of antibiotic resistance among multidrug/carbapenem-resistant Klebsiella pneumoniae isolates from a tertiary care hospital in Saudi Arabia