{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:49:57Z","timestamp":1791910197543,"version":"4.3.4"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T00:00:00Z","timestamp":1791417600000},"content-version":"vor","delay-in-days":9,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,9,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Hypervirulent Klebsiella pneumoniae (hvKp) is poorly characterized in North America and likely underrecognized. We evaluated a molecular screening approach for hvKp and described the clinical, microbiological, and genomic characteristics of hvKp isolates in Vancouver, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a retrospective study of sterile-site Kp isolates recovered at a tertiary care center (2018\u20132024). Archived isolates were screened using polymerase chain reaction (PCR)\u00a0targeting peg-344 and iucA. Whole-genome sequencing was then performed, with hvKp defined as a Kleborate virulence score of \u22653. Clinical data were obtained through chart review. Genomic relatedness was assessed using reference-based multilocus sequence typing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 449 isolates, 43 were PCR positive for peg-344 and\/or iucA, and 38 met criteria for hvKp. Only 5 (13%) cases were suspected at the time of isolation. The molecular screen demonstrated 100% sensitivity and 98.8% specificity for hvKp detection. Compared with classical Kp, hvKp infection was independently associated with travel history (adjusted odds ratio [aOR], 9.73; 95% CI, 2.06\u201346.04) and residence in Vancouver's Downtown Eastside (DTES; aOR, 3.69; 95% CI, 1.05\u201312.97), but not with Indo-Pacific country of origin (aOR, 1.77; 95% CI, .49\u20136.37). Genomic analysis suggested possible local transmission between 2 DTES patients. K1\/K2 were the most common capsular serotypes. One ST15 hvKp isolate carried blaNDM, representing a convergent hypervirulent and carbapenem-resistant strain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Routine molecular screening improved detection of hvKp and revealed evolving epidemiology, including possible clonal transmission. Implementing laboratory-based molecular screening can enhance clinical recognition, guide evaluation for metastatic complications, and monitor the emergence of high-risk strains.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ofid\/ofag654","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T11:45:45Z","timestamp":1790941545000},"source":"Crossref","is-referenced-by-count":0,"title":["Hypervirulent\n                    <i>Klebsiella pneumoniae<\/i>\n                    Infections in Vancouver, Canada: A Clinical, Microbiological, and Genetic Retrospective Investigation"],"prefix":"10.1093","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3287-041X","authenticated-orcid":false,"given":"Emma C L","family":"Finlayson-Trick","sequence":"first","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of British Columbia , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9299-2040","authenticated-orcid":false,"given":"Aleksandra","family":"Stefanovic","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of British Columbia , Vancouver, British Columbia ,","place":["Canada"]},{"name":"Division of Medical Microbiology, St. Paul's Hospital , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3677-9776","authenticated-orcid":false,"given":"Michael","family":"Payne","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of British Columbia , Vancouver, British Columbia ,","place":["Canada"]},{"name":"Division of Medical Microbiology, St. Paul's Hospital , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leah","family":"Gowland","sequence":"additional","affiliation":[{"name":"Division of Medical Microbiology, St. Paul's Hospital , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer","family":"Bilawka","sequence":"additional","affiliation":[{"name":"Division of Medical Microbiology, St. Paul's Hospital , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gordon","family":"Ritchie","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of British Columbia , Vancouver, British Columbia ,","place":["Canada"]},{"name":"Division of Medical Microbiology, St. Paul's Hospital , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9891-8546","authenticated-orcid":false,"given":"Samuel D","family":"Chorlton","sequence":"additional","affiliation":[{"name":"BugSeq Bioinformatics, Inc. , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Matic","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of British Columbia , Vancouver, British Columbia ,","place":["Canada"]},{"name":"Division of Medical Microbiology, St. Paul's Hospital , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Leung","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of British Columbia , Vancouver, British Columbia ,","place":["Canada"]},{"name":"Division of Medical Microbiology, St. Paul's Hospital , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura F","family":"Mataseje","sequence":"additional","affiliation":[{"name":"National Microbiology Laboratory , Winnipeg, Manitoba ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc G","family":"Romney","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of British Columbia , Vancouver, British Columbia ,","place":["Canada"]},{"name":"Division of Medical Microbiology, St. Paul's Hospital , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9320-4499","authenticated-orcid":false,"given":"Christopher F","family":"Lowe","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of British Columbia , Vancouver, British Columbia ,","place":["Canada"]},{"name":"Division of Medical Microbiology, St. Paul's Hospital , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1583-5484","authenticated-orcid":false,"given":"Patrick","family":"Tang","sequence":"additional","affiliation":[{"name":"Department of Pathology and Laboratory Medicine, University of British Columbia , Vancouver, British Columbia ,","place":["Canada"]},{"name":"Division of Medical Microbiology, St. Paul's Hospital , Vancouver, British Columbia ,","place":["Canada"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,8]]},"reference":[{"key":"2026101312120557400_ofag654-B1","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/S0140-6736(24)01867-1","article-title":"Global burden of bacterial antimicrobial resistance 1990\u20132021: a systematic analysis with forecasts to 2050","volume":"404","author":"Naghavi","year":"2024","journal-title":"The Lancet"},{"key":"2026101312120557400_ofag654-B2","doi-asserted-by":"crossref","first-page":"iv5","DOI":"10.1093\/jac\/dkz283","article-title":"42936 pathogens from Canadian hospitals: 10 years of results (2007\u201316) from the CANWARD surveillance study","volume":"74","author":"Zhanel","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2026101312120557400_ofag654-B3","doi-asserted-by":"crossref","first-page":"80","DOI":"10.20411\/pai.v10i1.777","article-title":"Hypervirulent Klebsiella pneumoniae (hvKp): overview, epidemiology, and laboratory detection","volume":"10","author":"Al Ismail","year":"2025","journal-title":"Pathog Immun"},{"key":"2026101312120557400_ofag654-B4","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1111\/joim.13007","article-title":"Hypervirulent Klebsiella pneumoniae\u2014clinical and molecular perspectives","volume":"287","author":"Choby","year":"2020","journal-title":"J Intern Med"},{"key":"2026101312120557400_ofag654-B5","doi-asserted-by":"crossref","first-page":"1913","DOI":"10.1001\/archinte.1986.00360220057011","article-title":"Klebsiella pneumoniae liver abscess associated with septic endophthalmitis","volume":"146","author":"Liu","year":"1986","journal-title":"Arch Intern Med"},{"key":"2026101312120557400_ofag654-B6","doi-asserted-by":"crossref","first-page":"6115","DOI":"10.1128\/AAC.01127-16","article-title":"High prevalence of hypervirulent Klebsiella pneumoniae infection in China: geographic distribution, clinical characteristics, and antimicrobial resistance","volume":"60","author":"Zhang","year":"2016","journal-title":"Antimicrob Agents Chemother"},{"key":"2026101312120557400_ofag654-B7","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.cmi.2015.09.025","article-title":"Hypervirulent Klebsiella pneumoniae clones causing bacteraemia in adults in a teaching hospital in Barcelona, Spain (2007\u20132013)","volume":"22","author":"Cubero","year":"2016","journal-title":"Clin Microbiol Infect"},{"key":"2026101312120557400_ofag654-B8","doi-asserted-by":"crossref","first-page":"1047","DOI":"10.1099\/jmm.0.000309","article-title":"Prevalence of hypervirulent Klebsiella pneumoniae-associated genes rmpA and magA in two tertiary hospitals in Houston, TX, USA","volume":"65","author":"Chou","year":"2016","journal-title":"J Med Microbiol"},{"key":"2026101312120557400_ofag654-B9","doi-asserted-by":"crossref","first-page":"e61","DOI":"10.1155\/2013\/828741","article-title":"Population-based surveillance for hypermucoviscosity Klebsiella pneumoniae causing community-acquired bacteremia in calgary, Alberta","volume":"24","author":"Peirano","year":"2013","journal-title":"Can J Infect Dis Med Microbiol"},{"key":"2026101312120557400_ofag654-B10","doi-asserted-by":"crossref","first-page":"603","DOI":"10.1186\/s12879-022-07558-1","article-title":"Genomic surveillance for multidrug-resistant or hypervirulent Klebsiella pneumoniae among United States bloodstream isolates","volume":"22","author":"Kochan","year":"2022","journal-title":"BMC Infect Dis"},{"key":"2026101312120557400_ofag654-B11","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1016\/j.cmi.2020.05.012","article-title":"Detection of multiple hypervirulent Klebsiella pneumoniae strains in a New York city hospital through screening of virulence genes","volume":"27","author":"Parrott","year":"2021","journal-title":"Clin Microbiol Infect"},{"key":"2026101312120557400_ofag654-B12","doi-asserted-by":"crossref","first-page":"E645","DOI":"10.1503\/cmaj.211413","article-title":"Disseminated hypervirulent Klebsiella pneumoniae causing endophthalmitis, and lung and liver abscesses","volume":"194","author":"Doshi","year":"2022","journal-title":"CMAJ"},{"key":"2026101312120557400_ofag654-B13","doi-asserted-by":"crossref","DOI":"10.1128\/AAC.00517-19","article-title":"Two hypervirulent Klebsiella pneumoniae isolates producing a bla KPC-2 carbapenemase from a Canadian patient","volume":"63","author":"Mataseje","year":"2019","journal-title":"Antimicrob Agents Chemother"},{"key":"2026101312120557400_ofag654-B14","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1080\/21505594.2017.1317412","article-title":"Hypervirulence and hypermucoviscosity: two different but complementary Klebsiella spp. phenotypes?","volume":"8","author":"Catal\u00e1n-N\u00e1jera","year":"2017","journal-title":"Virulence"},{"key":"2026101312120557400_ofag654-B15","doi-asserted-by":"crossref","DOI":"10.1128\/spectrum.00719-23","article-title":"Development of a quadruple qRT-PCR assay for simultaneous identification of hypervirulent and carbapenem-resistant Klebsiella pneumoniae","volume":"12","author":"Xu","year":"2024","journal-title":"Microbiol Spectr"},{"key":"2026101312120557400_ofag654-B16","doi-asserted-by":"crossref","DOI":"10.1128\/mbio.02867-23","article-title":"Differentiation of hypervirulent and classical Klebsiella pneumoniae with acquired drug resistance","volume":"15","author":"Russo","year":"2024","journal-title":"mBio"},{"key":"2026101312120557400_ofag654-B17","first-page":"51","article-title":"Carbapenemase-producing hypervirulent Klebsiella pneumoniae in Alberta, Canada, 2016\u20132024","volume":"11","author":"Edirmanasinghe","year":"2026","journal-title":"J Assoc Med Microbiol Infect Dis"},{"key":"2026101312120557400_ofag654-B18","doi-asserted-by":"crossref","DOI":"10.1016\/j.heliyon.2024.e37050","article-title":"Development and evaluation of a duplex real-time multienzyme isothermal rapid amplification assay for the detection of hypervirulent Klebsiella pneumoniae in clinical spiked blood specimens","volume":"10","author":"Duan","year":"2024","journal-title":"Heliyon"},{"key":"2026101312120557400_ofag654-B19","article-title":"MOB-suite: software tools for clustering, reconstruction and typing of plasmids from draft assemblies","volume":"4","author":"Robertson","year":"2018","journal-title":"Microb Genom"},{"key":"2026101312120557400_ofag654-B20","doi-asserted-by":"crossref","first-page":"4188","DOI":"10.1038\/s41467-021-24448-3","article-title":"A genomic surveillance framework and genotyping tool for Klebsiella pneumoniae and its related species complex","volume":"12","author":"Lam","year":"2021","journal-title":"Nat Commun"},{"key":"2026101312120557400_ofag654-B21","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/s12941-025-00817-4","article-title":"Detection of hypervirulent Klebsiella pneumoniae (hvKp) strains directly from spiked blood cultures using a commercial loop-mediated isothermal amplification (LAMP) assay","volume":"24","author":"Fern\u00e1ndez Vecilla","year":"2025","journal-title":"Ann Clin Microbiol Antimicrob"},{"key":"2026101312120557400_ofag654-B22","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1093\/jac\/dkad346","article-title":"WGS of a cluster of MDR Shigella sonnei utilizing Oxford Nanopore R10.4.1 long-read sequencing","volume":"79","author":"Ritchie","year":"2024","journal-title":"J Antimicrob Chemother"},{"key":"2026101312120557400_ofag654-B23","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing","author":"Clinical and Laboratory Standards Institute (CLSI)","year":"2025","edition":"35th ed"},{"key":"2026101312120557400_ofag654-B24"},{"key":"2026101312120557400_ofag654-B25","doi-asserted-by":"crossref","first-page":"7962","DOI":"10.1038\/s41467-023-43802-1","article-title":"Klebsiella pneumoniae clinical isolates with features of both multidrug-resistance and hypervirulence have unexpectedly low virulence","volume":"14","author":"Kochan","year":"2023","journal-title":"Nat Commun"},{"key":"2026101312120557400_ofag654-B26","doi-asserted-by":"crossref","first-page":"38059","DOI":"10.1038\/s41598-025-21884-9","article-title":"Epidemiology, drug resistance, and molecular features of Klebsiella pneumoniae in southwest Shandong, China","volume":"15","author":"Han","year":"2025","journal-title":"Sci Rep"},{"key":"2026101312120557400_ofag654-B27"},{"key":"2026101312120557400_ofag654-B28","doi-asserted-by":"crossref","first-page":"997","DOI":"10.1007\/s10096-025-05043-6","article-title":"Uncomplicated pharyngitis due to family transmission of hypervirulent Klebsiella pneumoniae","volume":"44","author":"Gray","year":"2025","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2026101312120557400_ofag654-B29","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1186\/s12866-023-02808-x","article-title":"Clonal transmission of polymyxin B-resistant hypervirulent Klebsiella pneumoniae isolates coharboring blaNDM-1 and blaKPC-2 in a tertiary hospital in China","volume":"23","author":"Tang","year":"2023","journal-title":"BMC Microbiol"},{"key":"2026101312120557400_ofag654-B30","doi-asserted-by":"crossref","first-page":"1936","DOI":"10.1080\/22221751.2022.2103454","article-title":"Prevalence of hypervirulent and carbapenem-resistant Klebsiella pneumoniae under divergent evolutionary patterns","volume":"11","author":"Tian","year":"2022","journal-title":"Emerg Microbes Infect"},{"key":"2026101312120557400_ofag654-B31"},{"key":"2026101312120557400_ofag654-B32","doi-asserted-by":"crossref","first-page":"1218","DOI":"10.1093\/jac\/dkz028","article-title":"Convergence of virulence and MDR in a single plasmid vector in MDR Klebsiella pneumoniae ST15","volume":"74","author":"Lam","year":"2019","journal-title":"J Antimicrob Chemother"},{"key":"2026101312120557400_ofag654-B33","doi-asserted-by":"crossref","first-page":"6017","DOI":"10.2147\/IDR.S426901","article-title":"Characterization of ST11 and ST15 carbapenem-resistant hypervirulent Klebsiella pneumoniae from patients with ventilator-associated pneumonia","volume":"16","author":"Song","year":"2023","journal-title":"Infect Drug Resist"},{"key":"2026101312120557400_ofag654-B34","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1016\/j.jgar.2024.11.003","article-title":"Molecular characterization of ST15 carbapenem-resistant Klebsiella pneumoniae isolated in a single patient","volume":"40","author":"Hu","year":"2025","journal-title":"J Glob Antimicrob Resist"},{"key":"2026101312120557400_ofag654-B35","doi-asserted-by":"crossref","DOI":"10.1128\/CMR.00001-19","article-title":"Hypervirulent Klebsiella pneumoniae","volume":"32","author":"Russo","year":"2019","journal-title":"Clin Microbiol Rev"},{"key":"2026101312120557400_ofag654-B36","doi-asserted-by":"crossref","first-page":"2096","DOI":"10.1038\/s41467-025-57379-4","article-title":"Genomically defined hypervirulent Klebsiella pneumoniae contributed to early-onset increased mortality","volume":"16","author":"Tang","year":"2025","journal-title":"Nat Commun"},{"key":"2026101312120557400_ofag654-B37","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3201\/eid3101.241516","article-title":"A step forward in hypervirulent Klebsiella pneumoniae diagnostics","volume":"31","author":"Russo","year":"2025","journal-title":"Emerg Infect Dis"},{"key":"2026101312120557400_ofag654-B38","doi-asserted-by":"crossref","first-page":"107","DOI":"10.4161\/viru.22718","article-title":"Hypervirulent (hypermucoviscous) Klebsiella pneumoniae: a new and dangerous breed","volume":"4","author":"Shon","year":"2013","journal-title":"Virulence"}],"container-title":["Open Forum Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ofid\/advance-article-pdf\/doi\/10.1093\/ofid\/ofag654\/71668265\/ofag654.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/10\/ofag654\/71668265\/ofag654.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ofid\/article-pdf\/13\/10\/ofag654\/71668265\/ofag654.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T16:12:16Z","timestamp":1791907936000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ofid\/article\/doi\/10.1093\/ofid\/ofag654\/8876095"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,29]]},"references-count":38,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,9,29]]}},"URL":"https:\/\/doi.org\/10.1093\/ofid\/ofag654","relation":{},"ISSN":["2328-8957"],"issn-type":[{"value":"2328-8957","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,10]]},"published":{"date-parts":[[2026,9,29]]},"article-number":"ofag654"}}