Genomic evidence of convergence of multidrug resistance and enhanced virulence in carbapenem- and colistin-resistant <i>Klebsiella pneumoniae</i> from Turkey

Multidrug-resistant (MDR) <i>Klebsiella pneumoniae</i> (<i>Kp</i>) represents a growing public health threat worldwide. We performed genomic analyses of carbapenem- and/or colistin-resistant <i>Kp</i> isolates recovered from hospitalized patients at Meram Hospital in Konya, Turkey. Forty-four isolates were identified by matrix-assisted laser desorption ionization-time-of-flight mass spectrometry, and resistance phenotypes were confirmed using broth microdilution assays. Whole-genome sequencing (Illumina) and bioinformatic analyses were used to determine sequence types (STs), antimicrobial resistance (AMR) determinants, virulence factors, and plasmid profiles. The isolates belonged to five STs: ST2096 (70.4%), ST377 (13.6%), ST101 (4.5%), ST14 (2.3%), and one novel ST (ST8972), along with two untypeable strains. Clonal group 14 (CG14), comprising ST2096, ST14, and ST8972, was predominant. Global phylogenetic analysis showed that most ST2096 isolates belonged to a clade circulating in Turkey and other countries, suggesting an international spread of these high-risk clones. No plasmid-mediated <i>mcr</i> genes were detected; however, several chromosomal mutations in <i>mgrB</i> and <i>pmrB</i> were identified. Carbapenem resistance was largely driven by <i>bla</i>_OXA-48-like genes, with <i>bla</i>_KPC-2 co-detected in one isolate. Notably, 77.3% of isolates exhibited convergence of genotypes with high virulence potential and AMR, and only two isolates lacked high virulence potential. These findings highlight the rising burden of MDR <i>Kp</i> in Turkey and demonstrate an urgent need for robust One Health genomic surveillance across clinical and community settings throughout the globe. The spread of carbapenem- and colistin-resistant strains harboring enhanced virulence gene profiles in different geographical locations signals lapses in antimicrobial stewardship and infection control that can be mitigated by coordinated local and global efforts to address AMR.IMPORTANCEThe global rise of <i>Klebsiella pneumoniae</i> (<i>Kp</i>) resistant to last-resort antimicrobials represents a critical threat to public health. Despite this concern, data on the genetic drivers of resistance and virulence in Turkey remain scarce, resulting in significant gaps in local and global surveillance. This study addresses this need by providing a comprehensive genomic analysis of multidrug-resistant clinical <i>Kp</i> isolates, revealing the frequent convergence of antimicrobial resistance and genetic signatures indicative of enhanced virulence in these strains. Notably, most isolates belonged to ST2096, clustering with genomes from Turkey and other countries, highlighting the international spread of these high-risk clones. The emergence of these difficult-to-treat pathogens emphasizes the urgent need for targeted action, including sustained genomic surveillance, stronger infection prevention, and improved antimicrobial stewardship. Policymakers, clinicians, and public health stakeholders must collaborate to enhance diagnostic capacity, surveillance systems, and infection control, particularly in countries where existing gaps exacerbate the spread of multidrug-resistant pathogens with high-virulence genotypes.