Volume 13, Issue 4 (12-2025)                   JoMMID 2025, 13(4): 246-263 | Back to browse issues page

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Usman N I, Umar A F, Iliyasu M Y, Abdulwahab N M. Hypervirulent Klebsiella pneumoniae: Characterization, Pathogenesis, and Infectivity. JoMMID 2025; 13 (4) :246-263
URL: http://jommid.pasteur.ac.ir/article-1-634-en.html
Hypervirulent Klebsiella pneumoniae: Characterization, Pathogenesis, and Infectivity
Nazeef Idris Usman * , Ahmed Faruk Umar , Mahmud Yerima Iliyasu , Nana Maryam Abdulwahab
Department of Microbiology, Bauchi State University, Bauchi, Nigeria
Abstract:   (291 Views)
Hypervirulent Klebsiella pneumoniae (HvKp) is an emerging pathogen associated with severe and invasive infections, including pyogenic liver abscesses, septicemia, and pneumonia. Its hypervirulence is linked to enhanced capsular polysaccharide production resulting in hypermucoviscosity, efficient siderophore-mediated iron acquisition, and increased tissue invasiveness. HvKp strains are predominantly associated with capsular serotypes K1 and K2. HvKp poses an increasing public health threat due to its rising antimicrobial resistance, which complicates treatment strategies. This review aims to summarize the clinical impact, resistance patterns, and virulence mechanisms of HvKp infections, thereby highlighting their growing significance in clinical microbiology and infectious disease research. HvKp infections are increasingly prevalent, with studies demonstrating that 15–30% of Klebsiella isolates in endemic regions such as China and Taiwan are hypervirulent. These infections are associated with higher mortality rates, ranging from 8.1–16.7% for severe outcomes, including liver abscesses and sepsis. Furthermore, HvKp strains are frequently resistant to multiple antibiotics, with resistance rates to carbapenems ranging from 12–20% and frequent production of extended-spectrum β-lactamases (ESBLs). The hypermucoviscosity phenotype of HvKp contributes to its increased invasiveness, particularly in immunocompromised individuals, although HvKp notably also causes severe disease in immunocompetent hosts, resulting in infections that are particularly severe and difficult to treat. HvKp infections pose a growing global health threat due to their high prevalence, severe clinical outcomes, and increasing antimicrobial resistance. These strains require heightened clinical awareness and surveillance to better manage and prevent transmission, underscoring the need for continued research into their pathogenesis and resistance mechanisms. Ultimately, preventing HvKp infections in both community and hospital settings requires a multifaceted approach, encompassing improved public health practices, management of predisposing conditions such as diabetes mellitus, and stringent infection control measures within healthcare facilities.
 
Keywords: Klebsiella pneumoniae, hypervirulent K. pneumoniae (HvKp), Hypermucoviscosity, Virulence factors, Antimicrobial resistance, Pathogenesis, Invasive infections, Liver abscess
Full-Text [PDF 1259 kb]   (231 Downloads)    
Type of Study: Review article | Subject: Microbial pathogenesis
Received: 2023/12/7 | Accepted: 2025/12/10 | Published: 2026/02/3
References
1. Akinjogunla OJ, Odeyemi AT, Udofia EAS, Adefiranye OO, Yah CS, Ehinmore I, et al. Enterobacteriaceae isolates from clinical and household tap water samples: antibiotic resistance, screening for extended-spectrum, metallo- and ampC-beta-lactamases, and detection of blaTEM, blaSHV and blaCTX-M in Uyo, Nigeria. Germs. 2023; 13 (1): 50-9. [DOI:10.18683/germs.2023.1366] [PMID] [PMCID]
2. Russo TA. Capsule and lipopolysaccharide. In: Donnenberg MS, editor. Escherichia coli: virulence mechanisms of a versatile pathogen. Amsterdam: Academic Press; 2002. p. 379-403. [DOI:10.1016/B978-012220751-8/50015-X] [PMID]
3. Kunduru BR, Nair SA, Rathinavelan T. EK3D: an E. coli K antigen 3-dimensional structure database. Nucleic Acids Res. 2016; 44 (D1): D675-81. [DOI:10.1093/nar/gkv1313] [PMID] [PMCID]
4. Li HF, Zhang LX, Zhang WL, Li J, Li YQ, Hu TP. Study on virulence genes, drug resistance and molecular epidemiology of Klebsiella pneumoniae with high virulence in Inner Mongolia, China. Infect Drug Resist. 2023; 16: 1133-44. [DOI:10.2147/IDR.S391468] [PMID] [PMCID]
5. Dong N, Yang X, Chan EWC, Zhang R, Chen S. Klebsiella species: Taxonomy, hypervirulence and multidrug resistance. EBioMedicine. 2022; 79: 103998. [DOI:10.1016/j.ebiom.2022.103998] [PMCID]
6. Paczosa MK, Mecsas J. Klebsiella pneumoniae: Going on the offense with a strong defense. Microbiol Mol Biol Rev. 2016; 80 (3): 629-61. [DOI:10.1128/MMBR.00078-15] [PMID] [PMCID]
7. Aggarwal N, Lotfollahzadeh S. Recurrent urinary tract infections. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023. Available from: http://www.ncbi.nlm.nih.gov/books/NBK557479
8. Russo TA, Olson R, Fang CT, Stoesser N, Miller M, MacDonald U, et al. Identification of biomarkers for differentiation of hypervirulent Klebsiella pneumoniae from classical K. pneumoniae. J Clin Microbiol. 2018; 56 (9): e00776-18. [DOI:10.1128/JCM.00776-18] [PMID]
9. Fang CT, Chuang YP, Shun CT, Chang SC, Wang JT. A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exp Med. 2004; 199 (5): 697-705. [DOI:10.1084/jem.20030857] [PMID] [PMCID]
10. Lan P, Jiang Y, Zhou J, Yu Y. A global perspective on the convergence of hypervirulence and carbapenem resistance in Klebsiella pneumoniae. J Glob Antimicrob Resist. 2021; 25: 26-34. [DOI:10.1016/j.jgar.2021.02.020] [PMID]
11. Rastegar S, Moradi M, Kalantar-Neyestanaki D, Golabi dehdasht A, Hosseini-Nave H. Virulence factors, capsular serotypes and antimicrobial resistance of hypervirulent Klebsiella pneumoniae and classical Klebsiella pneumoniae in Southeast Iran. Infect Chemother. 2021; 53 (1): e39.
12. Kot B, Piechota M, Szweda P, Mitrus J, Wicha J, Grużewska A, et al. Virulence analysis and antibiotic resistance of Klebsiella pneumoniae isolates from hospitalised patients in Poland. Sci Rep. 2023; 13: 4448. [DOI:10.1038/s41598-023-31086-w] [PMID]
13. Elbrolosy A, Eissa NA, Al-Rajhy NA, El-Mahdy EESA, Mostafa RG. Characterization of virulence genetic profile and resistance patterns of clinical Klebsiella pneumoniae isolates: classic versus hypermucoviscous phenotypes. Microbes Infect Dis. 2021; 2 (3): 516-528. [DOI:10.21608/mid.2021.74461.1147]
14. Shapaka JT, Muloiwa R, Buys H. Association of full blood count findings with risk of mortality in children with Klebsiella pneumoniae bloodstream infection at a South African children's hospital. BMC Pediatr. 2023; 23 (1): 302. [DOI:10.1186/s12887-023-04104-z] [PMID]
15. Chen Q, Wang M, Han M, Xu L, Zhang H. Molecular basis of Klebsiella pneumoniae colonization in host. Microb Pathog. 2023; 177: 106026. [DOI:10.1016/j.micpath.2023.106026] [PMID]
16. Wang Q, Yu H, Pan X, Huang W, Lalsiamthara J, Ullah S, et al. Exploring current hypervirulent Klebsiella pneumoniae infections: insights into pathogenesis, drug resistance, and vaccine prospects. Front Microbiol. 2025; 16: 1604763. [DOI:10.3389/fmicb.2025.1604763] [PMID] [PMCID]
17. Wang JL, Shang YY, Guo SY, Diao FF, Yu JY, Wei XH, et al. Serotype and virulence genes of Klebsiella pneumoniae isolated from mink and its pathogenesis in mice and mink. Sci Rep. 2017; 7 (1): 17291. [DOI:10.1038/s41598-017-17681-8] [PMID] [PMCID]
18. Chen D, Zhang Y, Wu J, Li J, Chen H, Zhang X, et al. Analysis of hypervirulent Klebsiella pneumoniae and classic Klebsiella pneumoniae infections in a Chinese hospital. J Appl Microbiol. 2022; 132 (5): 3883-90. [DOI:10.1111/jam.15476] [PMID] [PMCID]
19. Xu Y, Zhang J, Wang M, Liu M, Liu G, Qu H, et al. Mobilization of the nonconjugative virulence plasmid from hypervirulent Klebsiella pneumoniae. Genome Med. 2021; 13 (1): 119. [DOI:10.1186/s13073-021-00936-5] [PMID] [PMCID]
20. Usman NI, Umar AF, Iliyasu MY. Clinical and molecular characterisation of multidrug-resistant hypervirulent Klebsiella pneumoniae (MDR-HvKp) isolated from patient attending ATBU Teaching Hospital Bauchi. Eu J Microbiol Infect Dis. 2024; 1 (2): 53-65. [DOI:10.5455/EJMID.20240613123830]
21. Russo TA, Alvarado CL, Davies CJ, Drayer ZJ, Carlino-MacDonald U, Hutson A, et al. Differentiation of hypervirulent and classical Klebsiella pneumoniae with acquired drug resistance. mBio. 2024; 15 (2): e02867-23. [DOI:10.1128/mbio.02867-23] [PMCID]
22. Usman NI. Phenotypic characterization, detection of virulence factors, and antibacterial susceptibility profile of clinical isolates of Klebsiella pneumoniae. Gadau J Pure Alli Sci. 2022; 1 (2): 121-32. [DOI:10.54117/gjpas.v1i2.11]
23. Abbas R, Chakkour M, Zein El Dine H, Obaseki EF, Obeid ST, Jezzini A, et al. General overview of Klebsiella pneumoniae: Epidemiology and the role of siderophores in its pathogenicity. Biology (Basel). 2024; 13 (2): 78. [DOI:10.3390/biology13020078] [PMID] [PMCID]
24. Catalán-Nájera JC, Garza-Ramos U, Barrios-Camacho H. Hypervirulence and hypermucoviscosity: Two different but complementary Klebsiella spp. phenotypes? Virulence. 2017; 8 (7): 1111-23. [DOI:10.1080/21505594.2017.1317412] [PMID] [PMCID]
25. Zhu J, Wang T, Chen L, Du H. Virulence factors in hypervirulent Klebsiella pneumoniae. Front Microbiol. 2021; 12: 642484. [DOI:10.3389/fmicb.2021.642484] [PMCID]
26. Xu Q, Yang X, Chan EWC, Chen S. The hypermucoviscosity of hypervirulent K. pneumoniae confers the ability to evade neutrophil-mediated phagocytosis. Virulence. 2021; 12 (1): 2050-59. [DOI:10.1080/21505594.2021.1960101] [PMID] [PMCID]
27. Ono R, Kitagawa I. Positive string test in a patient with hypermucoviscous Klebsiella pneumoniae infection. QJM. 2021; 114 (11): 815. [DOI:10.1093/qjmed/hcab215] [PMID]
28. Liu YN, Zhang YF, Xu Q, Qiu Y, Lu QB, Wang T, et al. Infection and co-infection patterns of community-acquired pneumonia in patients of different ages in China from 2009 to 2020: a national surveillance study. Lancet Microbe. 2023; 4 (5): e330-9. [DOI:10.1016/S2666-5247(23)00031-9] [PMID]
29. Dey T, Chakrabortty A, Kapoor A, Warrier A, Nag VL, Sivashanmugam K, et al. Unusual hypermucoviscous clinical isolate of Klebsiella pneumoniae with no known determinants of hypermucoviscosity. Microbiol Spectr. 2022; 10 (3): e0039322. [DOI:10.1128/spectrum.00393-22] [PMID]
30. Osama DM, Zaki BM, Khalaf WS, Mohamed MYA, Tawfick MM, Amin HM. Occurrence and molecular study of hypermucoviscous/hypervirulence trait in gut commensal K. pneumoniae from healthy subjects. Microorganisms. 2023; 11 (3): 704. [DOI:10.3390/microorganisms11030704] [PMID]
31. Chang CY, Ong ELC. Positive string test in hypervirulent Klebsiella pneumoniae liver abscess. Oxf Med Case Rep. 2022; 2022 (4): omac035. [DOI:10.1093/omcr/omac035] [PMID] [PMCID]
32. Wang W, Ye C, Zhao B, Zheng Y, Zhang G, Su J, et al. Epidemiological and molecular characteristics of hypermucoviscous and hypervirulent Klebsiella pneumoniae isolates in community patients in Shanghai, China. Infect Drug Resist. 2024; 17: 2685-99. [DOI:10.2147/IDR.S468482] [PMID] [PMCID]
33. Lan Y, Zhou M, Li X, Liu X, Li J, Liu W. Preliminary investigation of iron acquisition in hypervirulent Klebsiella pneumoniae mediated by outer membrane vesicles. Infect Drug Resist. 2022; 15: 311-20. [DOI:10.2147/IDR.S342368] [PMID] [PMCID]
34. Sun HQ, Lu XM, Gao PJ. The exploration of the antibacterial mechanism of Fe3+ against bacteria. Braz J Microbiol. 2011; 42 (1): 410-4. [DOI:10.1590/S1517-83822011000100050] [PMCID]
35. Chen T, Dong G, Zhang S, Zhang X, Zhao Y, Cao J, et al. Effects of iron on the growth, biofilm formation and virulence of Klebsiella pneumoniae causing liver abscess. BMC Microbiol. 2020; 20 (1): 36. [DOI:10.1186/s12866-020-01727-5] [PMID] [PMCID]
36. de Paiva Lourenção LF, Suano-Souza FI, Fonseca FLA, Simões TMR, da Silva R, Sarni ROS. Impact of inflammation on anemia in children: a cross-sectional study. BMC Pediatr. 2025; 25 (1): 272. [DOI:10.1186/s12887-025-05639-z] [PMID] [PMCID]
37. Wu J, Chen J, Wang Y, Meng Q, Zhao J. Siderophore iucA of hypermucoviscous Klebsiella pneumoniae promotes liver damage in mice by inducing oxidative stress. Biochem Biophys Rep. 2022; 32: 101376. [DOI:10.1016/j.bbrep.2022.101376] [PMID] [PMCID]
38. Namikawa H, Niki M, Niki M, Oinuma KI, Yamada K, Nakaie K, et al. Siderophore production as a biomarker for Klebsiella pneumoniae strains that cause sepsis: A pilot study. J Formos Med Assoc. 2022; 121 (4): 848-55. [DOI:10.1016/j.jfma.2021.06.027]
39. Russo TA, MacDonald U, Hassan S, Camanzo E, LeBreton F, Corey B, et al. An assessment of siderophore production, mucoviscosity, and mouse infection models for defining the virulence spectrum of hypervirulent Klebsiella pneumoniae. mSphere. 2021; 6 (2): e00045-21. [DOI:10.1128/mSphere.00045-21] [PMID] [PMCID]
40. Karampatakis T, Tsergouli K, Behzadi P. Carbapenem-resistant Klebsiella pneumoniae: Virulence factors, molecular epidemiology and latest updates in treatment options. Antibiotics. 2023; 12 (2): 234. [DOI:10.3390/antibiotics12020234] [PMID] [PMCID]
41. Suay-García B, Pérez-Gracia MT. Present and Future of Carbapenem-Resistant Enterobacteriaceae Infections. In: Bawa R, editor. Advances in Clinical Immunology, Medical Microbiology, COVID-19, and Big Data. 1st ed. Singapore: Jenny Stanford Publishing; 2021. p. 255-280.
42. Abdel Salam SA, Anwar MA, Montasser KA, Abo El Magd NM. Distribution of rmpA gene and biofilm formation among hypervirulent Klebsiella pneumoniae isolates from Ain Shams University Hospitals. Microbes Infect Dis. 2023; 4 (4): 1344-54.
43. Spadar A, Perdigão J, Campino S, Clark TG. Genomic analysis of hypervirulent Klebsiella pneumoniae reveals potential genetic markers for differentiation from classical strains. Sci Rep. 2022; 12: 13671. [DOI:10.1038/s41598-022-17995-2]
44. Gomes AFR, Sousa E, Resende DISP. A practical toolkit for the detection, isolation, quantification, and characterization of siderophores and metallophores in microorganisms. ACS Omega. 2024; 9 (25): 26863-77. [DOI:10.1021/acsomega.4c03042] [PMCID]
45. Auld DS, Coassin PA, Coussens NP, Hensley P, Klumpp-Thomas C, Michael S, et al. Microplate selection and recommended practices in high-throughput screening and quantitative biology. In: Markossian S, Grossman A, Baskir H, et al., editors. Assay Guidance Manual [Internet]. Bethesda (MD): Eli Lilly & Company and the National Center for Advancing Translational Sciences; 2004. 2020 Jun 1 [cited 2026 Jan 4]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558077/.
46. Xu L, Li J, Wu W, Wu X, Ren J. Klebsiella pneumoniae capsular polysaccharide: Mechanism in regulation of synthesis, virulence, and pathogenicity. Virulence. 2024; 15 (1): 2439509. [DOI:10.1080/21505594.2024.2439509] [PMID] [PMCID]
47. Soni J, Sinha S, Pandey R. Understanding bacterial pathogenicity: a closer look at the journey of harmful microbes. Front Microbiol. 2024; 15: 1370818. [DOI:10.3389/fmicb.2024.1370818] [PMID] [PMCID]
48. Brissac T, Martínez E, Kruckow KL, Riegler AN, Ganaie F, Im H, et al. Capsule promotes intracellular survival and vascular endothelial cell translocation during invasive pneumococcal disease. mBio. 2021; 12 (5): e02516-21. [DOI:10.1128/mBio.02516-21] [PMID] [PMCID]
49. Fursova AD, Fursov MV, Astashkin EI, Novikova TS, Fedyukina GN, Kislichkina AA, et al. Early response of antimicrobial resistance and virulence genes expression in classical, hypervirulent, and hybrid hvKP-MDR Klebsiella pneumoniae on antimicrobial stress. Antibiotics. 2022; 11 (1): 7. [DOI:10.3390/antibiotics11010007] [PMID] [PMCID]
50. Russo TA, Lebreton F, McGann PT. A step forward in hypervirulent Klebsiella pneumoniae diagnostics. Emerg Infect Dis. 2025; 31 (1): e1-e3. [DOI:10.3201/eid3101.241516] [PMID] [PMCID]
51. Hetta HF, Alanazi FE, Sayed Ali MA, Alatawi AD, Aljohani HM, Ahmed R, et al. Hypervirulent Klebsiella pneumoniae: Insights into virulence, antibiotic resistance, and fight strategies against a superbug. Pharmaceuticals. 2025; 18 (5): 724. [DOI:10.3390/ph18050724] [PMID] [PMCID]
52. Candan ED, Aksöz N. Klebsiella pneumoniae: characteristics of carbapenem resistance and virulence factors. Acta Biochim Pol. 2015; 62 (4): 867-74. [DOI:10.18388/abp.2015_1148] [PMID]
53. Rao SS, Fernandes AM. Detection of hypervirulence genes and drug resistance in Klebsiella pneumoniae in diagnostic microbiology. Scientifica (Cairo). 2025; 2025: 8545710. [DOI:10.1155/sci5/8545710] [PMID] [PMCID]
54. Abbas R, Chakkour M, Zein El Dine H, Obaseki EF, Obeid ST, Jezzini A, et al. General overview of Klebsiella pneumoniae: Epidemiology and the role of siderophores in its pathogenicity. Biology (Basel). 2024; 13 (2): 78. [DOI:10.3390/biology13020078] [PMID] [PMCID]
55. Thapa TB, Maharjan S, Giri N, Sapkota M, Shrestha O, Khanal PR, et al. Incidence of hypermucoviscous Klebsiella pneumoniae and phenotypic detection of their virulence factors along with classical strains among patients visiting tertiary care hospital. J Infect Dev Ctries. 2025; 19 (2): 258-66. [DOI:10.3855/jidc.19456] [PMID]
56. Pan WK, Chen SN, Yang MJ, Tao LP, Wang MQ, Zhang XW, et al. Major predominant serotypes and virulence genes and antibiotic resistance characteristics of Klebsiella pneumoniae clinical isolates in Middle and East China. Infect Drug Resist. 2025; 18: 1451-64. [DOI:10.2147/IDR.S502323] [PMID] [PMCID]
57. Rao SS, Fernandes AM. Detection of hypervirulence genes and drug resistance in Klebsiella pneumoniae in diagnostic microbiology. Scientifica (Cairo). 2025; 2025: 8545710. [DOI:10.1155/sci5/8545710] [PMID] [PMCID]
58. Liao CH, Huang YT, Hsueh PR. Multicenter surveillance of capsular serotypes, virulence genes, and antimicrobial susceptibilities of Klebsiella pneumoniae causing bacteremia in Taiwan, 2017-2019. Front Microbiol. 2022; 13: 783523. [DOI:10.3389/fmicb.2022.783523] [PMID] [PMCID]
59. Hasani A, Soltani E, Ahangarzadeh Rezaee M, Pirzadeh T, Ahangar Oskouee M, Hasani A, et al. Serotyping of Klebsiella pneumoniae and its relation with capsule-associated virulence genes, antimicrobial resistance pattern, and clinical infections: A descriptive study in medical practice. Infect Drug Resist. 2020; 13: 1971-80. [DOI:10.2147/IDR.S243984] [PMID] [PMCID]
60. Regué M, Hita B, Piqué N, Izquierdo L, Merino S, Fresno S, et al. A gene, uge, is essential for Klebsiella pneumoniae virulence. Infect Immun. 2004; 72 (1): 54-61. [DOI:10.1128/IAI.72.1.54-61.2004] [PMID] [PMCID]
61. Alhassan UMA, Abdul-Kareem IQ. Molecular identification of virulence and antimicrobial resistance genes of Klebsiella pneumoniae isolated from the patients. J Med Pharm Chem Res. 2025; 7: 733-44.
62. Zhao Y, Zhang S, Fang R, Wu Q, Li J, Zhang Y, et al. Dynamic epidemiology and virulence characteristics of carbapenem-resistant Klebsiella pneumoniae in Wenzhou, China from 2003 to 2016. Infect Drug Resist. 2020; 13: 931-40. [DOI:10.2147/IDR.S243032] [PMID] [PMCID]
63. Chan KS, Yu WL, Tsai CL, Cheng KC, Hou CC, Lee MC, et al. Pyogenic liver abscess caused by Klebsiella pneumoniae: analysis of the clinical characteristics and outcomes of 84 patients. Chin Med J (Engl). 2007; 120 (2): 136-9. [DOI:10.1097/00029330-200701020-00012] [PMID]
64. Amraie H, Shakib P, Rouhi S, Bakhshandeh N, Zamanzad B. Prevalence assessment of magA gene and antimicrobial susceptibility of Klebsiella pneumoniae isolated from clinical specimens in Shahrekord, Iran. Iran J Microbiol. 2014; 6 (5): 311-6.
65. Yu WL, Ko WC, Cheng KC, Lee HC, Ke DS, Lee CC, et al. Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan. Clin Infect Dis. 2006; 42 (10): 1351-8. [DOI:10.1086/503420] [PMID]
66. Woodward R, Yi W, Li L, Zhao G, Eguchi H, Perali RS, et al. In vitro bacterial polysaccharide biosynthesis: Defining the functions of Wzy and Wzz. Nat Chem Biol. 2010; 6 (6): 418-23. [DOI:10.1038/nchembio.351] [PMID] [PMCID]
67. Dai P, Hu D. The making of hypervirulent Klebsiella pneumoniae. J Clin Lab Anal. 2022; 36 (12): e24743. [DOI:10.1002/jcla.24743] [PMID] [PMCID]
68. Mohammed ES, Flayyih MT. Detection of rmpA and magA genes and hypermucoviscosity phenotype in Klebsiella pneumoniae isolated from water samples in compare with clinical isolates clinical isolates. Curr Res Microbiol Biotechnol. 2018; 6 (1): 1424-30.
69. Hsu CR, Lin TL, Chen YC, Chou HC, Wang JT. The role of Klebsiella pneumoniae rmpA in capsular polysaccharide synthesis and virulence revisited. Microbiology (Reading). 2011; 157 (Pt 12): 3446-57. [DOI:10.1099/mic.0.050336-0] [PMID]
70. Tang M, Kong X, Hao J, Liu J. Epidemiological characteristics and formation mechanisms of multidrug-resistant hypervirulent Klebsiella pneumoniae. Front Microbiol. 2020; 11: 581543. [DOI:10.3389/fmicb.2020.581543] [PMID] [PMCID]
71. Chasteen TG, Fuentes DE, Tantaleán JC, Vásquez CC. Tellurite: history, oxidative stress, and molecular mechanisms of resistance. FEMS Microbiol Rev. 2009; 33 (4): 820-32. [DOI:10.1111/j.1574-6976.2009.00177.x] [PMID]
72. Nguyen TTH, Kikuchi T, Tokunaga T, Iyoda S, Iguchi A. Diversity of the tellurite resistance gene operon in Escherichia coli. Front Microbiol. 2021; 12: 681175. [DOI:10.3389/fmicb.2021.681175] [PMID] [PMCID]
73. Wang G, Zhao G, Chao X, Xie L, Wang H. The characteristic of virulence, biofilm and antibiotic resistance of Klebsiella pneumoniae. Int J Environ Res Public Health. 2020; 17 (17): 6278. [DOI:10.3390/ijerph17176278] [PMID] [PMCID]
74. Zhao B, Hu R, Gong L, Wang X, Zhu Y, Wu G. Pyogenic liver abscess and endogenous endophthalmitis due to K64-ST1764 hypervirulent Klebsiella pneumoniae: A case report. Infect Drug Resist. 2021; 14: 71-7. [DOI:10.2147/IDR.S289088] [PMID] [PMCID]
75. Rao SS, Fernandes AM. Detection of hypervirulence genes and drug resistance in Klebsiella pneumoniae in diagnostic microbiology. Scientifica (Cairo). 2025; 2025: 8545710. [DOI:10.1155/sci5/8545710] [PMID] [PMCID]
76. Kot B, Witeska M, Szweda P, Piechota M, Kondera E, Horoszewicks, et al. Antibiotic resistance, virulence genes, and molecular diversity of clinical Klebsiella pneumoniae isolates from patients of district hospital in central Poland. Pathogens. 2025; 14 (7): 648. [DOI:10.3390/pathogens14070648] [PMID] [PMCID]
77. Al-Kamoosi AMH, Al-Azawi IH. Detection of capsular polysaccharide virulence genes rmpA and magA of Klebsiella pneumonia isolate from diabetic foot ulcer patient in Najaf Governorate in Iraq. Indian J Forensic Med Toxicol. 2021; 15 (2): 3061-7. [DOI:10.37506/ijfmt.v15i2.14841]
78. Singh RP, Kapoor A, Sinha A, Ma Y, Shankar M. Virulence factors of Klebsiella pneumoniae: insights into canonical and emerging mechanisms driving pathogenicity and drug resistance. The Microbe. 2025; 7: 100289. [DOI:10.1016/j.microb.2025.100289]
79. Russo TA, MacDonald U, Hassan S, Camanzo E, LeBreton F, Corey B, et al. An assessment of siderophore production, mucoviscosity, and mouse infection models for defining the virulence spectrum of hypervirulent Klebsiella pneumoniae. mSphere. 2021; 6 (2): e00045-21. [DOI:10.1128/mSphere.00045-21] [PMID] [PMCID]
80. Wu X, Zhan F, Zhang J, Chen S, Yang B. Identification of hypervirulent Klebsiella pneumoniae carrying terW gene by MacConkey-potassium tellurite medium in the general population. Front Public Health. 2022; 10: 946370. [DOI:10.3389/fpubh.2022.946370] [PMID] [PMCID]
81. Pranavathiyani G, Prava J, Rajeev AC, Pan A. Novel target exploration from hypothetical proteins of Klebsiella pneumoniae MGH 78578 reveals a protein involved in host-pathogen interaction. Front Cell Infect Microbiol. 2020; 10: 109. [DOI:10.3389/fcimb.2020.00109] [PMID] [PMCID]
82. Raj S, Sharma T, Pradhan D, Tyagi S, Gautam H, Singh H, et al. Comparative analysis of clinical and genomic characteristics of hypervirulent Klebsiella pneumoniae from hospital and community settings: Experience from a tertiary healthcare center in India. Microbiol Spectr. 2022; 10 (5): e0037622. [DOI:10.1128/spectrum.00376-22] [PMID] [PMCID]
83. Usman NI, Umar A, Iliyasu M. Clinical and molecular characterisation of multi drug resistant hypervirulent Klebsiella pneumoniae (MDR-HvKp) isolated from patient attending ATBU Teaching Hospital Bauchi. Eu J Microbiol Infect Dis. 2024; 1 (2): 53-65. [DOI:10.5455/EJMID.20240613123830]
84. Usman NI, Abdulwahab NM, Sulaiman MJ, Abdullahi S. Multidrug resistance (MDR), extensive drug resistance (XDR), and pan drug resistance (PDR) Klebsiella pneumoniae from clinical samples. Sule Lamido Univ J Sci Technol. 2022; 3 (1-2): 42-50. [DOI:10.5455/sf.98561]
85. Ali MR, Yang Y, Dai Y, Lu H, He Z, Li Y, et al. Prevalence of multidrug-resistant hypervirulent Klebsiella pneumoniae without defined hypervirulent biomarkers in Anhui, China: a new dimension of hypervirulence. Front Microbiol. 2023; 14: 1247091. [DOI:10.3389/fmicb.2023.1247091] [PMID] [PMCID]
86. Sharma S, Mohler J, Mahajan SD, Schwartz SA, Bruggemann L, Aalinkeel R. Microbial biofilm: A review on formation, infection, antibiotic resistance, control measures, and innovative treatment. Microorganisms. 2023; 11 (6): 1614. [DOI:10.3390/microorganisms11061614] [PMID] [PMCID]
87. Akinpelu S, Ajayi A, Smith SI, Adeleye AI. Efflux pump activity, biofilm formation and antibiotic resistance profile of Klebsiella spp. isolated from clinical samples at Lagos University Teaching Hospital. BMC Res Notes. 2020; 13: 258. [DOI:10.1186/s13104-020-05105-2] [PMID] [PMCID]
88. Roberge N, Neville N, Douchant K, Noordhof C, Boev N, Sjaarda C, et al. Broad-spectrum inhibitor of bacterial polyphosphate homeostasis attenuates virulence factors and helps reveal novel physiology of Klebsiella pneumoniae and Acinetobacter baumannii. Front Microbiol. 2021; 12: 764733. [DOI:10.3389/fmicb.2021.764733] [PMID] [PMCID]
89. Awoke T, Teka B, Seman A, Sebre S, Yeshitela B, Aseffa A, Mihret A, Abebe T. High prevalence of multidrug-resistant Klebsiella pneumoniae in a tertiary care hospital in Ethiopia. Antibiotics (Basel). 2021; 10 (8): 1007. [DOI:10.3390/antibiotics10081007] [PMID] [PMCID]
90. Esperatti M, Ferrer M, Theessen A, Liapikou A, Valencia M, Saucedo LM, et al. Nosocomial pneumonia in the intensive care unit acquired by mechanically ventilated versus nonventilated patients. Am J Respir Crit Care Med. 2010; 182 (12): 1533-9. [DOI:10.1164/rccm.201001-0094OC] [PMID]
91. Raoofi S, Pashazadeh Kan F, Rafiei S, Hosseinipalangi Z, Noorani Mejareh Z, Khani S, et al. Global prevalence of nosocomial infection: A systematic review and meta-analysis. PLoS One. 2023; 18 (1): e0274248. [DOI:10.1371/journal.pone.0274248] [PMID] [PMCID]
92. Chen Q, Zhang Y, Zhang L, Xian S, Huang L, Ding X, et al. Liver abscess complicated with multiple organ invasive infection caused by hematogenous disseminated hypervirulent Klebsiella pneumoniae: A case report. Open Med (Wars). 2023; 18 (1): 20230694. [DOI:10.1515/med-2023-0694] [PMID] [PMCID]
93. Reeves P. Role of O-antigen variation in the immune response. Trends Microbiol. 1995; 3 (10): 381-6. [DOI:10.1016/S0966-842X(00)88983-0] [PMID]
94. Doorduijn DJ, Rooijakkers SHM, van Schaik W, Bardoel BW. Complement resistance mechanisms of Klebsiella pneumoniae. Immunobiology. 2016; 221 (10): 1102-9. [DOI:10.1016/j.imbio.2016.06.014] [PMID]
95. Opstrup KV, Bennike TB, Christiansen G, Birkelund S. Complement killing of clinical Klebsiella pneumoniae isolates is serum concentration dependent. Microbes Infect. 2023; 25 (4): 105074. [DOI:10.1016/j.micinf.2022.105074] [PMID]
96. Bulati M, Busà R, Carcione C, Iannolo G, Di Mento G, Cuscino N, et al. Klebsiella pneumoniae lipopolysaccharides serotype O2afg induce poor inflammatory immune responses ex vivo. Microorganisms. 2021; 9 (6): 1317. [DOI:10.3390/microorganisms9061317] [PMID] [PMCID]
97. Wei S, Xu T, Chen Y, Zhou K. Autophagy, cell death, and cytokines in K. pneumoniae infection: therapeutic perspectives. Emerg Microbes Infect. 2023; 12 (1): 2140607. [DOI:10.1080/22221751.2022.2140607] [PMID] [PMCID]
98. Bulati M, Busà R, Carcione C, Iannolo G, Di Mento G, Cuscino N, Di Gesù R, Piccionello AP, Buscemi S, Carreca AP, Barbera F, Monaco F, Cardinale F, Conaldi PG, Douradinha B. Klebsiella pneumoniae lipopolysaccharides serotype O2afg induce poor inflammatory immune responses ex vivo. Microorganisms. 2021;9 (6): 1247. [DOI:10.3390/microorganisms9061317] [PMID] [PMCID]
99. van der Geest R, Fan H, Peñaloza HF, Bain WG, Xiong Z, Kohli N, et al. Phagocytosis is a primary determinant of pulmonary clearance of clinical Klebsiella pneumoniae isolates. Front Cell Infect Microbiol. 2023; 13: 1150658. [DOI:10.3389/fcimb.2023.1150658] [PMID] [PMCID]
100. Dobó J, Kocsis A, Farkas B, Demeter F, Cervenak L, Gál P. The lectin pathway of the complement system-activation, regulation, disease connections and interplay with other (proteolytic) systems. Int J Mol Sci. 2024; 25 (3): 1566. [DOI:10.3390/ijms25031566] [PMID] [PMCID]
101. Ke Y, Zeng Z, Liu J, Ye C. Capsular polysaccharide as a potential target in hypervirulent and drug-resistant Klebsiella pneumoniae treatment. Infect Drug Resist. 2025; 18: 1253-62. [DOI:10.2147/IDR.S493635]
102. Tian T, Han H, Guan ZH, Zhang K, Huang X, Wang W, et al. A systematic review of hypervirulent Klebsiella pneumoniae research: bibliometric and topic modeling perspectives. Front Med (Lausanne). 2025; 12: 1545678. [DOI:10.3389/fmed.2025.1545678] [PMID] [PMCID]
103. Li Y, He Z, Wu F, Li J, Wang C. Recurrent invasive liver abscess syndrome induced by Klebsiella pneumoniae with emerging drug resistance: a case report and literature review. Front Med (Lausanne). 2025; 12: 1605284. [DOI:10.3389/fmed.2025.1605284] [PMID]
104. Baronos K, Scott S, Hebbes C. Disseminated hypervirulent Klebsiella pneumoniae infection following travel: A case of cavitating pneumonia, hepatic and renal abscesses, and thrombosis. Cureus. 2025; 17 (4): e82059. [DOI:10.7759/cureus.82059]
105. Sammarro M, Rowlingson B, Cocker D, Chidziwisano KR, Jacob ST, Kajumbula H, et al. Risk factors, temporal dependence, and seasonality of human extended-spectrum β-lactamases-producing Escherichia coli and Klebsiella pneumoniae colonization in Malawi: A longitudinal model-based approach. Clin Infect Dis. 2023; 77 (1): 1-8. [DOI:10.1093/cid/ciad117] [PMID] [PMCID]
106. DeLeo FR, Porter AR, Kobayashi SD, Freedman B, Hao M, Jiang J, et al. Interaction of multidrug-resistant hypervirulent Klebsiella pneumoniae with components of human innate host defense. mBio. 2023; 14 (5): e01949-23. [DOI:10.1128/mbio.01949-23] [PMID] [PMCID]
107. Rivera Antonio AM, Padilla Martínez II, Torres-Ramos MA, Rosales-Hernández MC. Myeloperoxidase as a therapeutic target for oxidative damage in Alzheimer's disease. J Enzyme Inhib Med Chem. 2025; 40 (1): 2456282. [DOI:10.1080/14756366.2025.2456282] [PMID] [PMCID]
108. Franklin CL. Microbial considerations in genetically engineered mouse research. ILAR J. 2006; 47 (2): 141-55. [DOI:10.1093/ilar.47.2.141] [PMID] [PMCID]
109. Gonzalez-Ferrer S, Peñaloza HF, Budnick JA, Bain WG, Nordstrom HR, Lee JS, et al. Finding order in the chaos: Outstanding questions in Klebsiella pneumoniae pathogenesis. Infect Immun. 2021; 89 (4): e00693-20. [DOI:10.1128/IAI.00693-20] [PMCID]
110. Álvarez D, Merino S, Tomás JM, Benedí VJ, Albertí S. Capsular polysaccharide is a major complement resistance factor in lipopolysaccharide O side chain-deficient Klebsiella pneumoniae clinical isolates. Infect Immun. 2000; 68 (2): 953-5. [DOI:10.1128/IAI.68.2.953-955.2000] [PMID] [PMCID]
111. Bai R, Guo J. Interactions and implications of Klebsiella pneumoniae with human immune responses and metabolic pathways: A comprehensive review. Infect Drug Resist. 2024; 17: 449-62. [DOI:10.2147/IDR.S451013] [PMID] [PMCID]
112. Ellermann M, Arthur JC. Siderophore-mediated iron acquisition and modulation of host-bacterial interactions. Free Radic Biol Med. 2017; 105: 68-78. [DOI:10.1016/j.freeradbiomed.2016.10.489] [PMID]
113. Kain MJW, Reece NL, Parry CM, Rajahram GS, Paterson DL, Woolley SD. The rapid emergence of hypervirulent Klebsiella species and Burkholderia pseudomallei as major health threats in Southeast Asia: The urgent need for recognition as neglected tropical diseases. Trop Med Infect Dis. 2024; 9 (4): 80. [DOI:10.3390/tropicalmed9040080] [PMID] [PMCID]
114. Abbas U, Kumar H, Hussain N, Ahmed I, Laghari RN, Tanveer M, et al. Immune dysregulation in type 2 diabetes mellitus: implications for tuberculosis, COVID-19, and HIV/AIDS. Infect Med. 2025; 4 (4): 100211. [DOI:10.1016/j.imj.2025.100211] [PMID] [PMCID]
115. Graves DT, Kayal RA. Diabetic complications and dysregulated innate immunity. Front Biosci. 2008; 13: 1227-39. [DOI:10.2741/2757] [PMID] [PMCID]
116. Ryu S, Chun JY, Lee S, Yoo D, Kim Y, Ali ST, et al. Epidemiology and transmission dynamics of infectious diseases and control measures. Viruses. 2022; 14 (11): 2510. [DOI:10.3390/v14112510] [PMID] [PMCID]
117. Doshi S, Forbes JD, Mubareka S, Andany N. Disseminated hypervirulent Klebsiella pneumoniae causing endophthalmitis, and lung and liver abscesses. CMAJ. 2022; 194 (18): E645-8. [DOI:10.1503/cmaj.211413] [PMID] [PMCID]
118. Joseph L, Merciecca T, Forestier C, Balestrino D, Miquel S. From Klebsiella pneumoniae colonization to dissemination: An overview of studies implementing murine models. Microorganisms. 2021; 9 (6): 1282. [DOI:10.3390/microorganisms9061282] [PMID] [PMCID]
119. Tang L, Wang H, Cao K, Li Y, Li T, Huang Y, et al. Epidemiological features and impact of high glucose level on virulence gene expression and serum resistance of Klebsiella pneumoniae causing liver abscess in diabetic patients. Infect Drug Resist. 2023; 16: 1221-30. [DOI:10.2147/IDR.S391349] [PMCID]
120. Usman NI, Umar A, Iliyasu M. Clinical and molecular characterisation of multi-drug resistant hypervirulent Klebsiella pneumoniae (MDR-HvKp) isolated from patients attending ATBU Teaching Hospital Bauchi. Eur J Microbiol Infect Dis. 2024; 1: 10-6. [DOI:10.5455/EJMID.20240613123830]
121. Loens K, Van Heirstraeten L, Malhotra-Kumar S, Goossens H, Ieven M. Optimal sampling sites and methods for detection of pathogens possibly causing community-acquired lower respiratory tract infections. J Clin Microbiol. 2009; 47 (1): 21-31. [DOI:10.1128/JCM.02037-08] [PMID] [PMCID]
122. Abi M, Chaitra S, Nabarro LEB, George MV, Balaji V. Hypervirulent, regulator of mucoid phenotype A positive Klebsiella pneumoniae liver abscess. J Glob Infect Dis. 2018; 10 (1): 30-1. [DOI:10.4103/jgid.jgid_86_16] [PMID] [PMCID]
123. Motowski H, Ilges D, Hampton N, Kollef MH, Micek ST. Determinants of mortality for ventilated hospital-acquired pneumonia and ventilator-associated pneumonia. Crit Care Explor. 2023; 5 (3): e0867. [DOI:10.1097/CCE.0000000000000867] [PMID] [PMCID]
124. Martins CC, Lockhart PB, Firmino RT, Kilmartin C, Cahill TJ, Dayer M, et al. Bacteremia following different oral procedures: Systematic review and meta-analysis. Oral Dis. 2024; 30 (3): 846-54. [DOI:10.1111/odi.14531] [PMID]
125. Jin SS, Wang WQ, Jiang YH, Yu YT, Wang RL. A comprehensive overview of Klebsiella pneumoniae: Resistance dynamics, clinical manifestations, and therapeutic options. Infect Drug Resist. 2025; 18: 1611-28. [DOI:10.2147/IDR.S502175] [PMID] [PMCID]
126. Michaelson NM. Community-acquired Klebsiella pneumoniae meningitis: questioning the demographic paradigm with new recommendations for diagnosis and effective treatment [abstract]. Neurology. 2019; 92 (15 Suppl): P5.9-025. [DOI:10.1212/WNL.92.15_supplement.P5.9-025]
127. AL-Khikani FHO, Abadi RM, Ayit AS. Emerging carbapenemase Klebsiella oxytoca with multidrug resistance implicated in urinary tract infection. Biomed Biotechnol Res J. 2020; 4 (2): 148-51. [DOI:10.4103/bbrj.bbrj_165_19]
128. Al-Badr A, Al-Shaikh G. Recurrent urinary tract infections management in women. Sultan Qaboos Univ Med J. 2013; 13 (3): 359-67. [DOI:10.12816/0003256] [PMCID]
129. Lee B, Yeroushalmi K, Me HM, Sojitra P, Jilani U, Iqbal S, et al. Community acquired Klebsiella pneumoniae meningitis: a case report. Germs. 2018; 8 (2): 92-5. [DOI:10.18683/germs.2018.1136] [PMCID]
130. Thi PL, Yassibanda S, Aidara A, Le Bouguénec C, Germani Y. Enteropathogenic Klebsiella pneumoniae HIV-infected adults, Africa. Emerg Infect Dis. 2003; 9 (1): 135-7. [DOI:10.3201/eid0901.020138] [PMID] [PMCID]
131. Banerjee T, Wangkheimayum J, Sharma S, Kumar A, Bhattacharjee A. Extensively drug-resistant hypervirulent Klebsiella pneumoniae from a series of neonatal sepsis in a tertiary care hospital, India. Front Med (Lausanne). 2021; 8: 645955. [DOI:10.3389/fmed.2021.645955] [PMID] [PMCID]
132. Hao H, Liu Y, Cao J, Gao K, Lu Y, Wang W, et al. Genomic new insights into emergence and clinical therapy of multidrug-resistant Klebsiella pneumoniae in infected pancreatic necrosis. Front Microbiol. 2021; 12: 669230. [DOI:10.3389/fmicb.2021.669230] [PMID] [PMCID]
133. Venkataraman R, Yadav U. Catheter-associated urinary tract infection: an overview. J Basic Clin Physiol Pharmacol. 2023; 34 (1): 5-10. [DOI:10.1515/jbcpp-2022-0152]
134. Mastrogianni M, Katsoulas T, Galanis P, Korompeli A, Myrianthefs P. The impact of care bundles on ventilator-associated pneumonia (VAP) prevention in adult ICUs: A systematic review. Antibiotics. 2023; 12 (2): 227. [DOI:10.3390/antibiotics12020227] [PMID] [PMCID]
135. Alshammari MK, Alotaibi MA, AlOtaibi AS, Alosaime HT, Aljuaid MA, Alshehri BM, et al. Prevalence and etiology of community- and hospital-acquired pneumonia in Saudi Arabia and their antimicrobial susceptibility patterns: a systematic review. Medicina (Kaunas). 2023; 59 (4): 641. [DOI:10.3390/medicina59040760]
136. Ranzani OT, Niederman MS, Torres A. Ventilator-associated pneumonia. Intensive Care Med. 2022; 48 (9): 1222-6. [DOI:10.1007/s00134-022-06773-3] [PMID]
137. Jones BE, Sarvet AL, Ying J, Jin R, Nevers MR, Stern SE, et al. Incidence and outcomes of non-ventilator-associated hospital-acquired pneumonia in 284 US hospitals using electronic surveillance criteria. JAMA Netw Open. 2023 May 1;6(5):e2314185. [DOI:10.1001/jamanetworkopen.2023.14185] [PMCID]
138. McCauley L, Kirwan M, Matthews A. The factors contributing to missed care and non-compliance in infection prevention and control practices of nurses: A scoping review. Int J Nurs Stud Adv. 2021; 3: 100039. [DOI:10.1016/j.ijnsa.2021.100039] [PMID] [PMCID]
139. Kohbodi GA, Rajasurya V, Noor A. Ventilator-associated pneumonia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Updated 2023 Sep 4; cited 2026 Jan 4. Available from: https://www.ncbi.nlm.nih.gov/books/NBK507711.
140. Martin-Loeches I, Povoa P, Rodríguez A, Curcio D, Suarez D, Mira JP, et al. Incidence and prognosis of ventilator-associated tracheobronchitis (TAVeM): a multicentre, prospective, observational study. Lancet Respir Med. 2015; 3 (11): 859-68. [DOI:10.1016/S2213-2600(15)00326-4] [PMID]
141. Idrees MM, Saeed K, Shahid MA, Akhtar M, Qammar K, Hassan J, et al. Prevalence of mecA- and mecC-associated methicillin-resistant Staphylococcus aureus in clinical specimens, Punjab, Pakistan. Biomedicines. 2023; 11 (3): 878. [DOI:10.3390/biomedicines11030878] [PMID] [PMCID]
142. Werneburg GT. Catheter-associated urinary tract infections: Current challenges and future prospects. Res Rep Urol. 2022; 14: 109-33. [DOI:10.2147/RRU.S273663] [PMCID]
143. Satpathy P, Diggikar P, Misra R, Wasekar M. Case of severe Friedlander's pneumonia with review of the literature. Med J Dr DY Patil Univ. 2014; 7 (2): 232-5. [DOI:10.4103/0975-2870.126365]
144. Zhao Q, Guo L, Wang L, Zhao Q, Shen D. Prevalence and characteristics of surgical site hypervirulent Klebsiella pneumoniae isolates. J Clin Lab Anal. 2020; 34 (9): e23364. [DOI:10.1002/jcla.23364] [PMID] [PMCID]
145. Akinpelu S, Ajayi A, Smith SI, Adeleye AI. Efflux pump activity, biofilm formation and antibiotic resistance profile of Klebsiella spp. isolated from clinical samples at Lagos University Teaching Hospital. BMC Res Notes. 2020; 13: 258. [DOI:10.1186/s13104-020-05105-2] [PMID]
146. Ali A, Gebretsadik D, Desta K. Incidence of surgical site infection, bacterial isolate, and their antimicrobial susceptibility pattern among patients who underwent surgery at Dessie Comprehensive Specialized Hospital, Northeast Ethiopia. SAGE Open Med. 2023;11:20503121231172345. [DOI:10.1177/20503121231172345] [PMID] [PMCID]
147. Han B, Feng C, Jiang Y, Ye C, Wei Y, Liu J, et al. Mobile genetic elements encoding antibiotic resistance genes and virulence genes in Klebsiella pneumoniae: important pathways for the acquisition of virulence and resistance. Front Microbiol. 2025; 16: 1529157. [DOI:10.3389/fmicb.2025.1529157] [PMCID]
148. Liu X, Xu L, Dong H, Qin S, Li Y, Yao H. ST11 carbapenem-resistant Klebsiella pneumoniae integrates virulence plasmid fragments into the chromosome via insertion sequence. BMC Microbiol. 2025; 25: 493. [DOI:10.1186/s12866-025-04235-6] [PMID] [PMCID]
149. Lee CR, , Lee JH, Park KS, Jeon JH, Kim YB, Cha CJ, et al. Antimicrobial resistance of hypervirulent Klebsiella pneumoniae: Epidemiology, hypervirulence-associated determinants, and resistance mechanisms. Front Cell Infect Microbiol. 2017; 7: 483. [DOI:10.3389/fcimb.2017.00483] [PMCID]
150. Tang M, Kong X, Hao J, Liu J. Epidemiological characteristics and formation mechanisms of multidrug-resistant hypervirulent Klebsiella pneumoniae. Front Microbiol. 2020; 11: 581543. [DOI:10.3389/fmicb.2020.581543] [PMID] [PMCID]
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