{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T04:31:45Z","timestamp":1791952305793,"version":"4.3.4"},"reference-count":30,"publisher":"American Society for Microbiology","issue":"10","license":[{"start":{"date-parts":[[2016,10,1]],"date-time":"2016-10-01T00:00:00Z","timestamp":1475280000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.asm.org\/non-commercial-tdm-license"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["81572036"],"award-info":[{"award-number":["81572036"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["journals.asm.org"],"crossmark-restriction":true},"short-container-title":["Antimicrob Agents Chemother"],"published-print":{"date-parts":[[2016,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Hypervirulent\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">Klebsiella pneumoniae<\/jats:named-content>\n                    (hvKP) is traditionally defined by hypermucoviscosity, but data based on genetic background are limited. Antimicrobial-resistant hvKP has been increasingly reported but has not yet been systematically studied.\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n                    isolates from bloodstream infections, hospital-acquired pneumonia, and intra-abdominal infections were collected from 10 cities in China during February to July 2013. Clinical data were collected from medical records. All\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n                    isolates were investigated by antimicrobial susceptibility testing, string test, extended-spectrum \u03b2-lactamase (ESBL) gene detection, capsular serotypes, virulence gene profiles, and multilocus sequence typing. hvKP was defined by aerobactin detection. Of 230\n                    <jats:named-content xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" content-type=\"genus-species\" xlink:type=\"simple\">K. pneumoniae<\/jats:named-content>\n                    isolates, 37.8% were hvKP. The prevalence of hvKP varied among different cities, with the highest rate in Wuhan (73.9%) and the lowest in Zhejiang (8.3%). Hypermucoviscosity and the presence of K1, K2, K20, and\n                    <jats:italic>rmpA<\/jats:italic>\n                    genes were strongly associated with hvKP (\n                    <jats:italic>P<\/jats:italic>\n                    &lt; 0.001). A significantly higher incidence of liver abscess (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.026), sepsis (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.038), and invasive infections (\n                    <jats:italic>P<\/jats:italic>\n                    = 0.043) was caused by hvKP. Cancer (odds ratio [OR], 2.285) and diabetes mellitus (OR, 2.256) appeared to be independent variables associated with hvKP infections by multivariate analysis. Importantly, 12.6% of hvKP isolates produced ESBLs, and most of them carried\n                    <jats:italic>bla<\/jats:italic>\n                    <jats:sub>CTX-M<\/jats:sub>\n                    genes. Patients with neutropenia (37.5% versus 5.6%;\n                    <jats:italic>P<\/jats:italic>\n                    = 0.020), history of systemic steroid therapy (37.5% versus 5.6%;\n                    <jats:italic>P<\/jats:italic>\n                    = 0.020), and combination therapy (62.5% versus 16.7%;\n                    <jats:italic>P<\/jats:italic>\n                    = 0.009) were more likely to be infected with ESBL-producing hvKP. The prevalence of hvKP is high in China and has a varied geographic distribution. ESBL-producing hvKP is emerging, suggesting an urgent need to enhance clinical awareness, especially for immunocompromised patients receiving combination therapy.\n                  <\/jats:p>","DOI":"10.1128\/aac.01127-16","type":"journal-article","created":{"date-parts":[[2016,8,1]],"date-time":"2016-08-01T23:04:34Z","timestamp":1470092674000},"page":"6115-6120","update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":282,"title":["High Prevalence of Hypervirulent Klebsiella pneumoniae Infection in China: Geographic Distribution, Clinical Characteristics, and Antimicrobial Resistance"],"prefix":"10.1128","volume":"60","author":[{"given":"Yawei","family":"Zhang","sequence":"first","affiliation":[{"name":"Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chunjiang","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaojuan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongbin","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Henan","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feifei","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuguang","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruobing","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"235","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-012-0374-y"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-011-1396-6"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00676-11"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00977-11"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.4161\/viru.22718"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02523-14"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cit675"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2180-11-50"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2015.07.010"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/21505594.2015.1030101"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1128\/IAI.01667-13"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.02173-15"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.3201\/eid2011.140206"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.01269-07"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cis565"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1089\/mdr.2013.0107"},{"key":"e_1_3_2_18_2","volume-title":"Approved standard","author":"Clinical and Laboratory Standards Institute","year":"2015","unstructured":"Clinical and Laboratory Standards Institute. 2015. 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