Hypervirulent Klebsiella pneumoniae

Abstract

Hypervirulent Klebsiella pneumoniae (hvKP), especially multidrug-resistant hvKP (MDR-hvKP) infections, are distributed globally, and lead to several outbreaks with high pathogenicity and mortality in immunocompetent individuals. This is usually characterized by a rapidly metastatic spread resulting in multiple pyogenic tissue abscesses. To date, even though the explanation of hypervirulent factors of hvKP has been identified, it still remains to be fully understood. The most common key virulence agents of hvKP included (1) siderophore systems for iron acquisition, (2) increased capsule production, (3) the colibactin toxin, (4) hypermucoviscosity, and so on. Several hypervirulence factors have been renewed, and the evolution of MDR-hvKP has been deeply explored recently. We aim to describe a chain of key virulence agents attributed to the lethality of hvKP and MDR-hvKP. In this review, recent advances in renewed factors in hypervirulence were summarized, and potential therapeutic targets are explored. Novel co-existence of hypervirulence agents and multidrug-resistant elements, even the superplasmid, was screened. Superplasmid simultaneously harbours hypervirulence and multidrug-resistant genes and can mobile autonomously by its complete conjugative elements. Research into related immunity has also gained traction, which may cause multiple invasive infections with higher mortality rates than classical ones, such as neutrophil-and complement-mediated activity. The evolution of virulence and multidrug resistance is accelerating. More reliable methods for identifying hvKP or MDR-hvKP must be investigated. Furthermore, it is critical to investigate innovative treatment targets in the future.

Microbiological and Clinical Characteristics of HypervirulentKlebsiella pneumoniaeisolated from Patients in Tertiary Centers

“…Our study also lacks information on the antimicrobial susceptibility profiles of the K. pneumoniae isolates. Hence, antibiogram data should be incorporated into hvKp surveillance studies in the future, as multidrug-resistant hvKp strains are increasingly being reported worldwide [25,26].…”

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

“…HvKp most commonly causes community-acquired infection in healthy individuals and is also associated with diabetes mellitus [ 48 , 49 , 50 , 51 ]. It typically causes cryptogenic, rapidly progressive, and metastatic abscess-forming disease, which is often fatal [ 52 ]. The remarkable ability of Klebsiella pneumoniae to share genetic information has led to the convergence of cKp and HvKp, leading to multi-drug resistant (MDR), hypervirulent strains [ 53 ] that pose an unmet, global health threat.…”

“…To counter this, Klebsiella pneumoniae secretes four siderophores, which can efficiently sequester both free and bound iron. The siderophores aerobactin and salmochelin are highly expressed in HvKp compared to cKp [ 52 ] and are associated with hypermucoid capsule production [ 61 ]. A high total siderophore concentration is also strongly predictive of HvKp [ 62 ].…”

Genomic surveillance indicates clonal replacement of hypervirulent Klebsiella pneumoniae ST881 and ST29 lineage strains in vivo

“…Though hvKp has been studied for nearly 40 years, its definition remains unclear and controversial ( Chen et al, 2023 ). Many studies summarized the differences between hvKp and CKP, clinical manifestations, capsule typing, hypermucoviscosity, and virulence genes are helpful to identify hvKp ( Choby et al, 2020 ).…”