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Clin Microbiol Rev. 2019 May 15;32(3). pii: e00001-19. doi: 10.1128/CMR.00001-19. Print 2019 Jun 19.

Hypervirulent Klebsiella pneumoniae.

Russo TA1,2,3,4, Marr CM5,6.

Author information

1
Department of Medicine, University at Buffalo-State University of New York, Buffalo, New York, USA trusso@buffalo.edu.
2
Department of Microbiology and Immunology, University at Buffalo-State University of New York, Buffalo, New York, USA.
3
The Witebsky Center for Microbial Pathogenesis, University at Buffalo-State University of New York, Buffalo, New York, USA.
4
The Veterans Administration Western New York Healthcare System, Buffalo, New York, USA.
5
Department of Medicine, University at Buffalo-State University of New York, Buffalo, New York, USA.
6
Erie County Medical Center, Buffalo, New York, USA.

Abstract

SUMMARYHypervirulent K. pneumoniae (hvKp) is an evolving pathotype that is more virulent than classical K. pneumoniae (cKp). hvKp usually infects individuals from the community, who are often healthy. Infections are more common in the Asian Pacific Rim but are occurring globally. hvKp infection frequently presents at multiple sites or subsequently metastatically spreads, often requiring source control. hvKp has an increased ability to cause central nervous system infection and endophthalmitis, which require rapid recognition and site-specific treatment. The genetic factors that confer hvKp's hypervirulent phenotype are present on a large virulence plasmid and perhaps integrative conjugal elements. Increased capsule production and aerobactin production are established hvKp-specific virulence factors. Similar to cKp, hvKp strains are becoming increasingly resistant to antimicrobials via acquisition of mobile elements carrying resistance determinants, and new hvKp strains emerge when extensively drug-resistant cKp strains acquire hvKp-specific virulence determinants, resulting in nosocomial infection. Presently, clinical laboratories are unable to differentiate cKp from hvKp, but recently, several biomarkers and quantitative siderophore production have been shown to accurately predict hvKp strains, which could lead to the development of a diagnostic test for use by clinical laboratories for optimal patient care and for use in epidemiologic surveillance and research studies.

KEYWORDS:

Friedlander’s bacillus; Klebsiella pneumoniae ; abscess; aerobactin; colonization; hypervirulent; infection control; metastatic spread; virulence determinants; virulence plasmid

PMID:
31092506
PMCID:
PMC6589860
[Available on 2020-05-15]
DOI:
10.1128/CMR.00001-19

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