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Abstract <p><i>Klebsiella pneumoniae</i> has a long history of causing infections as an opportunistic pathogen. There is an upsurge in infections caused by <i>K. pneumoniae,</i> mainly due to its two pathotypes, classical <i>K. pneumoniae</i> (cKP) and hypervirulent <i>K. pneumoniae</i> (hvKP).&#xa0;Various infections associated with these pathotypes include pneumonia, urinary tract infections, bloodstream infections, and pyogenic liver abscesses. This review provides an update on the pathogenicity, virulence factors, mechanisms of virulence, emergence and dissemination of multidrug resistance, as well as the convergence of virulence and resistance in <i>K. pneumoniae</i>, which is considered a significant threat to human health. The cKP infects only immunocompromised individuals, and these infections are mostly curable. However, hvKP can infect both healthy and immunocompromised individuals, and exhibits a strong defense against antibacterial therapy due to its hypermucoviscous characteristic. The increasing development of multidrug resistance among these strains poses a significant treatment challenge. Due to its enhanced pathogenicity, resistance against multiple antibacterial drugs, and capability for widespread transmission, multidrug-resistant hypervirulent <i>K. pneumoniae</i> (MDR-hvKP) has emerged as a global public health concern. The cKP may acquire virulence and resistance plasmids, resulting in MDR-cKP, which later transitions into MDR-hvKP. The hvKP becomes MDR-hvKP by acquiring resistance plasmids. Virulence plasmids are a characteristic feature of hvKP and are non-conjugative; however, these could be horizontally transferred with resistance plasmids. Additionally, virulence and resistance plasmids undergo recombination, resulting in hybrid MDR-hvKP plasmids aiding in the dissemination of virulence and resistance determinants.The convergence of virulence and resistance makes <i>K. pneumoniae</i> a very aggressive pathogen. The acquisition and recombination of virulence and resistance plasmids drive the emergence and global spread of MDR-hvKP, severely limiting therapeutic options. Understanding the genetic mechanisms underlying this convergence is essential for developing effective surveillance, infection control, and targeted therapeutic strategies to minimise the growing impact of MDR-hvKP infections.</p>

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A review on hypervirulent and multidrug-resistant Klebsiella pneumoniae: An emerging threat to human health

  • 期刊论文

  • 发表日期：

    2026年1月24日

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  • Shayan Ahmed,
  • Mohammad Saif,
  • Vikar Ahmed,
  • Owais Ahmad,
  • Syed Ahmed Rizvi,
  • Uzma Jabeen,
  • Sanover Khan,
  • Qazi Mohd Rizwanul Haq

摘要

Abstract

Klebsiella pneumoniae has a long history of causing infections as an opportunistic pathogen. There is an upsurge in infections caused by K. pneumoniae, mainly due to its two pathotypes, classical K. pneumoniae (cKP) and hypervirulent K. pneumoniae (hvKP). Various infections associated with these pathotypes include pneumonia, urinary tract infections, bloodstream infections, and pyogenic liver abscesses. This review provides an update on the pathogenicity, virulence factors, mechanisms of virulence, emergence and dissemination of multidrug resistance, as well as the convergence of virulence and resistance in K. pneumoniae, which is considered a significant threat to human health. The cKP infects only immunocompromised individuals, and these infections are mostly curable. However, hvKP can infect both healthy and immunocompromised individuals, and exhibits a strong defense against antibacterial therapy due to its hypermucoviscous characteristic. The increasing development of multidrug resistance among these strains poses a significant treatment challenge. Due to its enhanced pathogenicity, resistance against multiple antibacterial drugs, and capability for widespread transmission, multidrug-resistant hypervirulent K. pneumoniae (MDR-hvKP) has emerged as a global public health concern. The cKP may acquire virulence and resistance plasmids, resulting in MDR-cKP, which later transitions into MDR-hvKP. The hvKP becomes MDR-hvKP by acquiring resistance plasmids. Virulence plasmids are a characteristic feature of hvKP and are non-conjugative; however, these could be horizontally transferred with resistance plasmids. Additionally, virulence and resistance plasmids undergo recombination, resulting in hybrid MDR-hvKP plasmids aiding in the dissemination of virulence and resistance determinants.The convergence of virulence and resistance makes K. pneumoniae a very aggressive pathogen. The acquisition and recombination of virulence and resistance plasmids drive the emergence and global spread of MDR-hvKP, severely limiting therapeutic options. Understanding the genetic mechanisms underlying this convergence is essential for developing effective surveillance, infection control, and targeted therapeutic strategies to minimise the growing impact of MDR-hvKP infections.