الفهرس 
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Abstract
Background: AmpC beta-lactamases have a major role in mediating cefoxitin resistance which is escalating worldwide in pathogenic Klebsiella species. Two main pathogenic models of Klebsiella species are classical Klebsiella species and hypervirulent Klebsiella species. Objectives: The current study aimed to ascertain the risk factors for hypermucoviscous Klebsiella (hmK) species acquisition in patients with healthcare-associated infections (HAIs), the prevalence of cefoxitin-resistant hmK species in patients with HAIs and compare various phenotypic approaches to PCR for precise cefoxitin resistance detection. Methodology: 67 Klebsiella isolates were identified and classified as non-hmK and hmK phenotypes by string test. The boronic acid assay, Modified three-dimensional test, and AmpC cefoxitin-EDTA test were performed for phenotypic evaluation. Multiplex PCR assay was performed to evaluate the presence of AmpC genes in hypermucoviscous strains with cefoxitin resistance. Results: In relation to other Klebsiella infections, the prevalence of hmK species was 77.6%. The prevalence of hmK species among HAIs was 46.4%. The prevalence of cefoxitin-resistant hmK species among HAIs was 38.4%. The modified three-dimensional test yielded the highest results concerning the detection rates of the three confirmatory phenotypic techniques. Using multiplex PCR, 69.8% carried AmpC genes while 30.2% carried no genes. Conclusions: There is an alarming increase in HAIs caused by hmK species. The risk factors for the acquisition of hmK species in patients with HAIs are associated co-morbidities such as DM, liver diseases, malignancy, and history of ICU stays.