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A total of 660 carbapenem-resistant\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      (CRKp) and 69 LAKp isolates were screened for five hvKp-associated biomarkers (\n                      <jats:italic toggle=\"yes\">peg-344<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">iroB<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">iucA<\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">\n                        <jats:sub>p<\/jats:sub>\n                        rmpA\n                      <\/jats:italic>\n                      ,\n                      <jats:italic toggle=\"yes\">\n                        <jats:sub>p<\/jats:sub>\n                        rmpA2\n                      <\/jats:italic>\n                      ) and the string test. Among LAKp isolates, 49.3% were positive for all five biomarkers and the string test (5 genes-string test positive), while 39.1% carried all markers but were string test-negative (5 genes-string test negative). The seven-day post-infection survival rates of larvae infected with 5 genes-string test positive, 5 genes-string test negative, and other LAKp isolates were 5.9%, 10.4%, and 4.3%, respectively. In contrast, larvae infected with CRKp isolates showed higher survival rates of 7.1%, 17.9%, and 37.5% for the other groups. NTUH-K2044 and the hypervirulent isolates CRKp3, CRKp117, and LAKp88 exhibited higher lethality in bacteremia mice model compared to CRKp isolates lacking five virulence genes and string test negative. Moreover, 5 genes-string test negative LAKp produced the highest levels of capsule (117.7 ng\/10\u2076 CFU), followed by 5 genes-string test positive LAKp (101.4 ng\/10\u2076 CFU). Notably, carbapenem-resistant classical\n                      <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                      (CRcKp) isolates lacking five virulence genes and string test negative, markedly lower capsule levels (7.4 ng\/10\u2076 CFU) compared to other groups. These results suggest that the combined use of the five genetic markers and the string test enables effective identification of hvKp, and the capsule production is correlated with the virulence potential of the strains.\n                    <\/jats:p>\n                    <jats:sec>\n                      <jats:title>IMPORTANCE<\/jats:title>\n                      <jats:p>\n                        This study tackles the growing threat of\n                        <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                        strains that combine high antibiotic resistance with hypervirulence. By integrating genetic and phenotypic markers, we examined carbapenem-resistant\n                        <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                        (CRKp) and liver abscess-associated\n                        <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                        (LAKp) isolates. We found strong associations between five key virulence genes (\n                        <jats:italic toggle=\"yes\">peg-344<\/jats:italic>\n                        ,\n                        <jats:italic toggle=\"yes\">iroB<\/jats:italic>\n                        ,\n                        <jats:italic toggle=\"yes\">iucA<\/jats:italic>\n                        ,\n                        <jats:italic toggle=\"yes\">\n                          <jats:sub>p<\/jats:sub>\n                          rmpA\n                        <\/jats:italic>\n                        ,\n                        <jats:italic toggle=\"yes\">\n                          <jats:sub>p<\/jats:sub>\n                          rmpA2\n                        <\/jats:italic>\n                        ), positive string test results, high capsule production, and tellurite resistance. A 23-year surveillance of 1,815 carbapenem-susceptible isolates revealed that the proportion of blood isolates carrying all five virulence biomarkers, regardless of string test positivity, was significantly higher than that of urine isolates. Our findings provide a practical framework to enhance detection and risk assessment of hypervirulent\n                        <jats:italic toggle=\"yes\">K. pneumoniae<\/jats:italic>\n                        , while deepening understanding of the traits that drive their clinical impact.\n                      <\/jats:p>\n                    <\/jats:sec>\n                  <\/jats:sec>","DOI":"10.1128\/spectrum.02474-25","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T14:01:53Z","timestamp":1767794513000},"update-policy":"https:\/\/doi.org\/10.1128\/asmj-crossmark-policy-page","source":"Crossref","is-referenced-by-count":3,"title":["A combined genetic and phenotypic marker approach enables precise detection of hypervirulent\n                    <i>Klebsiella pneumoniae<\/i>\n                    and reveals associated traits of capsule overproduction and tellurite resistance"],"prefix":"10.1128","volume":"14","author":[{"given":"Tran Thi 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