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Background: Klebsiella pneumoniae causes severe diseases including sepsis, pneumonia
and wound infections and is differentiated into hypervirulent (hvKp) and classic (cKp) pathotypes.
hvKp isolates are characterized clinically by invasive and multiple site infection and phenotypically
in particular through hypermucoviscosity and increased siderophore production, enabled by the
presence of the respective virulence genes, which are partly carried on plasmids. Methods: Here, we
analyzed two K. pneumoniae isolates of a human patient that caused severe multiple site infection.
By applying both genomic and phenotypic experiments and combining basic science with clinical
approaches, we aimed at characterizing the clinical background as well as the two isolates in-depth.
This also included bioinformatics analysis of a chromosomal virulence plasmid integration event.
Results: Our genomic analysis revealed that the two isolates were clonal and belonged to sequence
type 420, which is not only the first description of this K. pneumoniae subtype in Germany but also
suggests belonging to the hvKp pathotype. The latter was supported by the clinical appearance and
our phenotypic findings revealing increased siderophore production and hypermucoviscosity similar
to an archetypical, hypervirulent K. pneumoniae strain. In addition, our in-depth bioinformatics
analysis suggested the insertion of a hypervirulence plasmid in the bacterial chromosome, mediated
by a new IS5 family sub-group IS903 insertion sequence designated ISKpn74. Conclusion: Our study
contributes not only to the understanding of hvKp and the association between hypervirulence and
clinical outcomes but reveals the chromosomal integration of a virulence plasmid, which might lead
to tremendous public health implications.