{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:52:37Z","timestamp":1786978357437,"version":"build-2736575974"},"reference-count":26,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T00:00:00Z","timestamp":1611619200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100009601","name":"Beijing Municipal Administration of Hospitals","doi-asserted-by":"publisher","award":["ZYLX201813"],"award-info":[{"award-number":["ZYLX201813"]}],"id":[{"id":"10.13039\/501100009601","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Investigation"],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>\n                      Hypervirulent variants of\n                      <jats:italic>Klebsiella pneumoniae<\/jats:italic>\n                      (hvKp) are capable of causing life\u2010threatening pyogenic liver abscesses (PLAs), but hvKp caused PLAs was seldom reported in pediatric populations. Hence, there is an urgent need to raise our awareness of this phenomenon in pediatric populations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aimed to report the clinical characteristics of hvKp that caused fatal PLA complicated by bacteremia in an adolescent and further identify the microbiological and genomic features of the causative strain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A 14\u2010year\u2010old boy with diabetes mellitus was admitted to our hospital with a diagnosis of PLA complicated by bacteremia. A hypermucoviscous hvKp strain, KPN_19\u2010106, was isolated from the drainage fluid present within the liver abscess cavity and blood. The hypermucoviscosity phenotype of the causative strain was determined by string test. Its virulence was measured using serum resistance assay and\n                      <jats:italic>Galleria mellonella<\/jats:italic>\n                      larvae\u2010killing assay. Antimicrobial susceptibility was determined by broth microdilution method. Genetic information was obtained by whole\u2010genome sequencing and bioinformatics analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      KPN_19\u2010106 belonged to sequence type 380 and serotype K2 and exhibited stronger serum resistance and higher\n                      <jats:italic>in vivo<\/jats:italic>\n                      lethality than the well\u2010characterized hvKp NTUH\u2010K2044 strain. Although KPN_19\u2010106 is susceptible to most antibiotics, no sign of improvement was observed during treatment with such drugs. Whole\u2010genome sequencing revealed that the isolate had integrated multiple mobile genetic elements related to virulence.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>\n                      Antibiotic\u2010susceptible hvKp can cause fatal PLA complicated by bacteremia in adolescents, with no improvement during antimicrobial therapy. The causative strain in this case had integrated multiple virulence genes and thus exhibited higher virulence both\n                      <jats:italic>in vitro<\/jats:italic>\n                      and\n                      <jats:italic>in vivo<\/jats:italic>\n                      when compared with NTUH\u2010K2044.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ped4.12238","type":"journal-article","created":{"date-parts":[[2021,1,26]],"date-time":"2021-01-26T23:29:15Z","timestamp":1611703755000},"page":"118-124","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["A fatal case of liver abscess caused by hypervirulent\n                    <i>Klebsiella pneumoniae<\/i>\n                    in a diabetic adolescent: A clinical and laboratory study"],"prefix":"10.1002","volume":"5","author":[{"given":"Yue","family":"Li","sequence":"first","affiliation":[{"name":"MOE Key Laboratory of Major Diseases in Children National Key Discipline of Pediatrics (Capital Medical University) National Clinical Research Center for Respiratory Diseases Beijing Key Laboratory of Pediatric Respiratory Infection Diseases Beijing Pediatric Research Institute Beijing Children\u2019s Hospital Capital Medical University National Center for Children\u2019s Health  China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit Beijing Children\u2019s Hospital Capital Medical University National Center for Children\u2019s Health  China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suyun","family":"Qian","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit Beijing Children\u2019s Hospital Capital Medical University National Center for Children\u2019s Health  China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fang","family":"Dong","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology Laboratory Beijing Children\u2019s Hospital Capital Medical University National Center for Children\u2019s Health  China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Wang","sequence":"additional","affiliation":[{"name":"MOE Key Laboratory of Major Diseases in Children National Key Discipline of Pediatrics (Capital Medical University) National Clinical Research Center for Respiratory Diseases Beijing Key Laboratory of Pediatric Respiratory Infection Diseases Beijing Pediatric Research Institute Beijing Children\u2019s Hospital Capital Medical University National Center for Children\u2019s Health  China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pengfei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Pediatric Intensive Care Unit Beijing Children\u2019s Hospital Capital Medical University National Center for Children\u2019s Health  China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kaihu","family":"Yao","sequence":"additional","affiliation":[{"name":"MOE Key Laboratory of Major Diseases in Children National Key Discipline of Pediatrics (Capital Medical University) National Clinical Research Center for Respiratory Diseases Beijing Key Laboratory of Pediatric Respiratory Infection Diseases Beijing Pediatric Research Institute Beijing Children\u2019s Hospital Capital Medical University National Center for Children\u2019s Health  China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2021,1,26]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-019-0615-2"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2015.09.025"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00001-19"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1128\/JB.00315-09"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.01924-13"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2180-11-50"},{"key":"e_1_2_6_8_1","unstructured":"Clinical and Laboratory Standards Institute [CLSI].Performance Standards for Antimicrobial Susceptibility Testing. 29th ed. 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