To evaluate the virulence levels of carbapenem-resistant ST191, ST195, and ST208, and to analyze the differences in virulence factors among these epidemic clones. The study involved the genomic sequencing of 233 strains that were isolated from the Fifth Medical Center of the Chinese People's Liberation Army General Hospital (North Hospital) between 2011 and 2019. The genomic data was cross-referenced with the Virulence Factor Database (VFDB) to examine the presence of virulence genes in the strains. Furthermore, a infection survival model was used to evaluate the virulence levels of the strains, and the association between virulence levels and virulence genes was analyzed. The study included 38 strains of the ST191 clone, 104 strains of the ST195 clone, and 91 strains of the ST208 clone. In the infection survival experiment, the average mortality rate for ST191 was 23.0%, with 3 (7.9%) highly virulent strains. For ST195, the average mortality rate was 53.0%, with 34 (32.7%) highly virulent strains. For ST208, the average mortality rate was 47.0%, with 20 (21.9%) highly virulent strains. There was a significant statistical difference in mortality rates between ST191 and ST195 (=13.9, <0.001) as well as between ST191 and ST208 (=15.2, <0.001). A comparison of the strains with the VFDB revealed significant differences in the virulence genes carried by the clones. Specifically, the type Ⅵ secretion system-related genes () and the sugar transferase gene were found to be universally absent in ST191 strains (0%) while being prevalent in ST195 (100.0%) and ST208 (>82.0%) strains. Statistical analysis revealed an association between the mortality rate of the clones and the presence of virulence genes( <0.001, =0.001, <0.001, <0.001, =0.001, =0.001, 0.001, =0.001, <0.001, <0.001, <0.001, =0.001, =0.001). Among the carbapenem-resistant epidemic clones of , the ST191 clone shows lower mortality rates in , possibly because of the lack of type Ⅵ secretion system and sugar transferase genes.
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