Objectives Klebsiella pneumoniae (Kp) bloodstream infections (BSIs) are a major concern in the Philippines, but local clinical and molecular epidemiologic data are limited. Methods We conducted a cross-sectional study at a government hospital in Manila from April 2023 to January 2024, analyzing clinical data with whole genome sequencing of 39 cases. Results Most patients were male (mean age 53 years) and had diabetes or malignancy. The in-hospital mortality rate was 38.5%. Extended-spectrum β-lactamase and carbapenemase genes were identified in 41.0% and 33.3% of isolates, respectively, predominantly blaCTX-M-15, blaNDM, and blaKPC. The most frequent sequence type was ST437, followed by ST23, ST101, and ST17. Hypervirulence genes (rmpA/A2, iuc, and iro) were detected in 25.6% of isolates, defining 10 hypervirulent Kp (hvKp) strains, including one carbapenem-resistant hvKp strain carrying blaNDM-7. Compared with classic Kp infections, hvKp infections resulted in higher rates of septic shock and infection-attributable mortality despite having lower multidrug resistance. Conclusion These findings underscore the high mortality risk from Kp BSIs, driven by antimicrobial resistance and hypervirulence. The detection of hvKp and carbapenem-resistant hvKp is testament to the global spread of this critical priority pathogen.
