Carbapenem-Resistant Klebsiella pneumoniae (CR-Kp) is a major public health threat, particularly among hospitalized, debilitated patients due to extremely limited treatment options. In contrary, hypervirulent Kp (HvKp) strains, which typically cause severe infections in otherwise healthy individuals in community settings, have remained largely susceptible to antibiotics. However, as highlighted by the WHO in 2024, the emergence of carbapenem resistant HvKp (CR-HvKp) strains presents a critical public health emergency, combining multi-drug resistance with heightened virulence and the capacity to cause severe, potentially untreatable infections in both hospitals and communities.  

In many Asian hospitals, where carbapenems are commonly used as the first-line empirical therapy, CR-HvKp strains may outcompete other gut flora facilitating persistent selection, colonization and transmission. In contexts where infection control measures are sub-optimal, this dynamic increases the risk of widespread dissemination into the boarder community. Despite its significance, fundamental questions remain about how and where this convergence between hypervirulence and resistance occurs, and how early emergence and transmission can be prevented or mitigated.  

In this study, we aim to address these gaps by undertaking an observational prospective cohort study. A stool and throat swab sample will be collected from a consenting hospitalized patient yielding K. pneumoniae during routine laboratory investigation, and from his care-giving close contacts at different time points during hospitalization and after discharge. Statistical, modelling and whole genome analyses of pathogenic and colonizing K. pneumoniae strains cultured from patients and their contacts samples integrated with spatiotemporally collected clinical, demographic, and laboratory will unravel the epidemiological pathways, transmission interfaces,and determinants underlying the emergence, spread, and evolution of CR-HvKp strains.