الفهرس 
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Abstract
Klebsiella pneumoniae is an opportunistic pathogen capable of causing a variety of infections. Classically, K. pneumoniae is known to cause pneumonia, urinary tract infections and bacteremia in immunocompromised or frequently healthcare-exposed patients (6).
In the past few decades a distinct type of K. pneumoniae termed hypervirulent K. pneumoniae (hvKP), has emerged as an important pathogen capable of causing community-acquired and, increasingly, hospital-acquired infections. Unlike cKP, hvKP often causes infection in otherwise healthy individuals (2)
HvKP was first recognized as a cause of pyogenic liver abscesses in Asia and is beginning to be appreciated for the frequency at which it causes other types of diseases as skin, soft tissue, bone infections, necrotizing fasciitis, neck and psoas abscesses, osteomyelitis and endophthalmitis. A defining feature of hvKP is a hypermucoid appearance on agar plates. Thus, hvKP has alternatively been referred to as hypermucoviscous (HMV) or hypermucoid K. pneumoniae to distinguish it from cKP (1).
Hypervirulent K. pneumoniae infections were primarily found in East Asia and now are increasingly being reported worldwide (3).
The aim of this work was to assess the antimicrobial susceptibility patterns of the collected community- and hospital-acquired K. pneumoniae isolates, determine their hypermucoviscosity and biofilm-forming ability by phenotypic methods and to clarify their relation to antimicrobial resistance. Presence of some of the suspected virulence genes in K. pneumoniae isolates was also verified by the multiplex PCR assay.
This study was performed in Medical Microbiology and Immunology Department, Faculty of Medicine, Menoufia University during the period from January 2018 to August 2019. Clinical samples were collected from 286 patients (aged from 9 to 74 years old with a mean age of 41.2± 5.5years) admitted to different departments and ICUs of MUHs as well as Outpatient Clinics. The study protocol was approved by local ethics committee of Menoufia University. An informed consent was obtained from each patient or the guardians of unaware patients.
A total of 340 clinical samples (95 blood, 64 sputum and 12 bronchial aspirate, 53 pus swabs, 37 drain samples, 32 ascitic fluid, 22 urine samples, 17 burn swabs and 8 CSF) were collected from 286 patients suffering from either community- or hospital-acquired infections. Samples were processed, and cultured onto different bacteriological media. K. pneumoniae isolates were identified by the automated Vitek- 2 system and the identified isolates were preserved on tryptic soy broth with 16% glycerol and frozen at -80°C.
A total of 84 K. pneumoniae isolates were isolated and the string test was applied to demonstrate hypermucoviscosity by using the inoculation loop to stretch the bacterial colonies on an agar plate from overnight culture. The formation of viscous string of more than 5mm in length was considered to be positive.