{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T10:07:36Z","timestamp":1789034856502,"version":"build-2803163510"},"reference-count":56,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T00:00:00Z","timestamp":1784678400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":50,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"the Chinese Medicine Scientific Research Foundation of Zhejiang Province","award":["2026ZL0059"],"award-info":[{"award-number":["2026ZL0059"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Microbiol"],"DOI":"10.1186\/s12866-026-05433-6","type":"journal-article","created":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T11:34:48Z","timestamp":1784720088000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Genomic, virulent and phenotypic characterization of a cerebrospinal fluid-derived ST86-KL2 hypervirulent Klebsiella pneumoniae isolate from a patient with meningitis and diabetes mellitus"],"prefix":"10.1186","volume":"26","author":[{"given":"Xiyun","family":"Lai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinyu","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Yan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tingjian","family":"Zou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengyuan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaofang","family":"Tang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiang","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,22]]},"reference":[{"key":"5433_CR1","doi-asserted-by":"publisher","first-page":"4","DOI":"10.3389\/fcimb.2018.00004","volume":"8","author":"RM Martin","year":"2018","unstructured":"Martin RM, Bachman MA. Colonization, Infection, and the Accessory Genome of Klebsiella pneumoniae. Front Cell Infect Microbiol. 2018;8:4. https:\/\/doi.org\/10.3389\/fcimb.2018.00004.","journal-title":"Front Cell Infect Microbiol"},{"issue":"3","key":"5433_CR2","doi-asserted-by":"publisher","first-page":"e00001","DOI":"10.1128\/CMR.00001-19","volume":"32","author":"TA Russo","year":"2019","unstructured":"Russo TA, Marr CM Hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev. 2019;32(3):e00001\u201319. https:\/\/doi.org\/10.1128\/CMR.00001-19.","journal-title":"Clin Microbiol Rev"},{"key":"5433_CR3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fpubh.2022.991306","volume":"10","author":"N Huang","year":"2022","unstructured":"Huang N, Jia H, Zhou B, Zhou C, Cao J, Liao W, et al. Hypervirulent carbapenem-resistant Klebsiella pneumoniae causing highly fatal meningitis in southeastern China. Front Public Health. 2022;10:1\u201311. https:\/\/doi.org\/10.3389\/fpubh.2022.991306.","journal-title":"Front Public Health"},{"key":"5433_CR4","doi-asserted-by":"publisher","first-page":"185","DOI":"10.1016\/j.ijid.2021.11.013","volume":"114","author":"G Rollin","year":"2022","unstructured":"Rollin G, Rossi B, Brisse S, Decr\u00e9 D, Leflon-Guibout V, Bert F, et al. Spontaneous and postsurgical\/traumatic Klebsiella pneumoniae meningitis: two distinct clinico-microbiological entities. Int J Infect Dis. 2022;114:185\u201391. https:\/\/doi.org\/10.1016\/j.ijid.2021.11.013.","journal-title":"Int J Infect Dis"},{"key":"5433_CR5","doi-asserted-by":"publisher","first-page":"35","DOI":"10.1016\/j.jgar.2023.08.006","volume":"35","author":"H Hu","year":"2023","unstructured":"Hu H, Wang H, Yu M, Feng H, Zhang S, Zhang Y, et al. Clinical and microbiological characteristics of carbapenem-resistant Enterobacteriaceae causing post-operative central nervous system infections in China. J Global Antimicrob Resist. 2023;35:35\u201343. https:\/\/doi.org\/10.1016\/j.jgar.2023.08.006.","journal-title":"J Global Antimicrob Resist"},{"key":"5433_CR6","doi-asserted-by":"publisher","first-page":"95","DOI":"10.1016\/j.jgar.2021.02.035","volume":"27","author":"Y Li","year":"2021","unstructured":"Li Y, Hu D, Ma X, Li D, Tian D, Gong Y, et al. Convergence of carbapenem resistance and hypervirulence leads to high mortality in patients with postoperative Klebsiella pneumoniae meningitis. J Global Antimicrob Resist. 2021;27:95\u2013100. https:\/\/doi.org\/10.1016\/j.jgar.2021.02.035.","journal-title":"J Global Antimicrob Resist"},{"issue":"6","key":"5433_CR7","doi-asserted-by":"publisher","first-page":"346","DOI":"10.1007\/s15010-002-3010-4","volume":"30","author":"CR Huang","year":"2002","unstructured":"Huang CR, Lu CH, Chang HW, Lee PY, Lin MW, Chang WN. Community-acquired spontaneous bacterial meningitis in adult diabetic patients: an analysis of clinical characteristics and prognostic factors. Infection. 2002;30(6):346\u201350. https:\/\/doi.org\/10.1007\/s15010-002-3010-4.","journal-title":"Infection"},{"key":"5433_CR8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.micres.2025.128262","volume":"299","author":"W Zeng","year":"2025","unstructured":"Zeng W, Sun Y, Zhang J, Yao Z, Cao J, Hu P, et al. Outer membrane protein A mediates Klebsiella pneumoniae penetration of the blood-brain barrier and induces bacterial meningitis. Microbiol Res. 2025;299:1\u201315. https:\/\/doi.org\/10.1016\/j.micres.2025.128262.","journal-title":"Microbiol Res"},{"key":"5433_CR9","doi-asserted-by":"publisher","first-page":"4927","DOI":"10.2147\/IDR.S376055","volume":"15","author":"Z Zhang","year":"2022","unstructured":"Zhang Z, Wen H, Wang H, Zhang P, Li J, Liang Y, et al. A Case of Meningitis in an Infant Due to Hypervirulent Klebsiella pneumoniae Transmission Within a Family. Infect Drug Resist. 2022;15:4927\u201333. https:\/\/doi.org\/10.2147\/IDR.S376055.","journal-title":"Infect Drug Resist"},{"issue":"1","key":"5433_CR10","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-017-06878-6","volume":"7","author":"YH Ku","year":"2017","unstructured":"Ku YH, Chuang YC, Chen CC, Lee MF, Yang YC, Tang HJ, et al. Klebsiella pneumoniae Isolates from Meningitis: Epidemiology, Virulence and Antibiotic Resistance. Sci Rep. 2017;7(1):1\u201310. https:\/\/doi.org\/10.1038\/s41598-017-06878-6.","journal-title":"Sci Rep"},{"key":"5433_CR11","volume-title":"Performance standards for antimicrobial susceptibility testing. 35th informational supplement (CLSI M100-S35)","author":"CLSI","year":"2025","unstructured":"CLSI. Performance standards for antimicrobial susceptibility testing. 35th informational supplement (CLSI M100-S35). Wayne, PA: Clinical and Laboratory Standards Institute; 2025."},{"key":"5433_CR12","unstructured":"European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters. version 16.0. 2026. Available at https:\/\/www.eucast.org\/fileadmin\/eucast\/pdf\/breakpoints\/v_16.0_Breakpoint_Tables.pdf."},{"issue":"4","key":"5433_CR13","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1002\/ams2.40","volume":"1","author":"H Hagiya","year":"2014","unstructured":"Hagiya H, Watanabe N, Maki M, Murase T, Otsuka F. Clinical utility of string test as a screening method for hypermucoviscosity-phenotype Klebsiella pneumoniae. Acute Med Surg. 2014;1(4):245\u20136. https:\/\/doi.org\/10.1002\/ams2.40.","journal-title":"Acute Med Surg"},{"issue":"1","key":"5433_CR14","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1080\/21505594.2022.2158980","volume":"14","author":"R Liu","year":"2023","unstructured":"Liu R, Xu H, Zhao J, Hu X, Wu L, Qiao J, et al. Emergence of mcr-8.2-harboring hypervirulent ST412 Klebsiella pneumoniae strain from pediatric sepsis: a comparative genomic survey. Virulence. 2023;14(1):233\u201345. https:\/\/doi.org\/10.1080\/21505594.2022.2158980.","journal-title":"Virulence"},{"key":"5433_CR15","doi-asserted-by":"publisher","first-page":"506","DOI":"10.1186\/s12866-024-03637-2","volume":"24","author":"Y Liu","year":"2024","unstructured":"Liu Y, Liu X, Xu H, Zhang X, Liu R, Chen M, et al. Genomic and phenotypic characterization of ST2012 clinical Klebsiella quasipneumoniae subsp. similipneumoniae harboring blaNDM\u20131 in China. BMC Microbiol. 2024;24:506. https:\/\/doi.org\/10.1186\/s12866-024-03637-2.","journal-title":"BMC Microbiol"},{"issue":"6","key":"5433_CR16","doi-asserted-by":"publisher","first-page":"e1005595","DOI":"10.1371\/journal.pcbi.1005595","volume":"13","author":"RR Wick","year":"2017","unstructured":"Wick RR, Judd LM, Gorrie CL, Holt KE. Unicycler: resolving bacterial genome assemblies from short and long sequencing reads. PLoS Comput Biol. 2017;13(6):e1005595. https:\/\/doi.org\/10.1371\/journal.pcbi.1005595.","journal-title":"PLoS Comput Biol"},{"issue":"5","key":"5433_CR17","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1101\/gr.215087.116","volume":"27","author":"S Koren","year":"2017","unstructured":"Koren S, Walenz BP, Berlin K, Miller JR, Bergman NH, Phillippy AM. Canu: scalable and accurate long-read assembly via adaptive k-mer weighting and repeat separation. Genome Res. 2017;27(5):722\u201336. https:\/\/doi.org\/10.1101\/gr.215087.116.","journal-title":"Genome Res"},{"issue":"9","key":"5433_CR18","doi-asserted-by":"publisher","first-page":"1297","DOI":"10.1101\/gr.107524.110","volume":"20","author":"A McKenna","year":"2010","unstructured":"McKenna A, Hanna M, Banks E, Sivachenko A, Cibulskis K, Kernytsky A, et al. The Genome Analysis Toolkit: a MapReduce framework for analyzing next-generation DNA sequencing data. Genome Res. 2010;20(9):1297\u2013303. https:\/\/doi.org\/10.1101\/gr.107524.110.","journal-title":"Genome Res"},{"issue":"14","key":"5433_CR19","doi-asserted-by":"publisher","first-page":"6614","DOI":"10.1093\/nar\/gkw569","volume":"44","author":"T Tatusova","year":"2016","unstructured":"Tatusova T, DiCuccio M, Badretdin A, Chetvernin V, Nawrocki EP, Zaslavsky L, et al. NCBI prokaryotic genome annotation pipeline. Nucleic Acids Res. 2016;44(14):6614\u201324. https:\/\/doi.org\/10.1093\/nar\/gkw569.","journal-title":"Nucleic Acids Res"},{"issue":"W1","key":"5433_CR20","doi-asserted-by":"publisher","first-page":"W46","DOI":"10.1093\/nar\/gkad344","volume":"51","author":"K Blin","year":"2023","unstructured":"Blin K, Shaw S, Augustijn HE, Reitz ZL, Biermann F, Alanjary M, et al. antiSMASH 7.0: new and improved predictions for detection, regulation, chemical structures and visualisation. Nucleic Acids Res. 2023;51(W1):W46\u201350. https:\/\/doi.org\/10.1093\/nar\/gkad344.","journal-title":"Nucleic Acids Res"},{"issue":"8","key":"5433_CR21","doi-asserted-by":"publisher","first-page":"4178","DOI":"10.1128\/JCM.43.8.4178-4182.2005","volume":"43","author":"L Diancourt","year":"2005","unstructured":"Diancourt L, Passet V, Verhoef J, Grimont PAD, Brisse S. Multilocus sequence typing of Klebsiella pneumoniae nosocomial isolates. J Clin Microbiol. 2005;43(8):4178\u201382. https:\/\/doi.org\/10.1128\/JCM.43.8.4178-4182.2005.","journal-title":"J Clin Microbiol"},{"key":"5433_CR22","doi-asserted-by":"publisher","first-page":"4188","DOI":"10.1038\/s41467-021-24448-3","volume":"12","author":"MMC Lam","year":"2021","unstructured":"Lam MMC, Wick RR, Watts SC, Cerdeira LT, Wyres KL, Holt KE. A genomic surveillance framework and genotyping tool for Klebsiella pneumoniae and its related species complex. Nat Commun. 2021;12:4188. https:\/\/doi.org\/10.1038\/s41467-021-24448-3.","journal-title":"Nat Commun"},{"issue":"12","key":"5433_CR23","doi-asserted-by":"publisher","first-page":"3491","DOI":"10.1093\/jac\/dkaa345","volume":"75","author":"V Bortolaia","year":"2020","unstructured":"Bortolaia V, Kaas RS, Ruppe E, Roberts MC, Schwarz S, Cattoir V, et al. ResFinder 4.0 for predictions of phenotypes from genotypes. J Antimicrob Chemother. 2020;75(12):3491\u2013500. https:\/\/doi.org\/10.1093\/jac\/dkaa345.","journal-title":"J Antimicrob Chemother"},{"issue":"D1","key":"5433_CR24","doi-asserted-by":"publisher","first-page":"D912","DOI":"10.1093\/nar\/gkab1107","volume":"50","author":"B Liu","year":"2022","unstructured":"Liu B, Zheng D, Zhou S, Chen L, Yang J. VFDB 2022: a general classification scheme for bacterial virulence factors. Nucleic Acids Res. 2022;50(D1):D912\u20137. https:\/\/doi.org\/10.1093\/nar\/gkab1107.","journal-title":"Nucleic Acids Res"},{"issue":"7","key":"5433_CR25","doi-asserted-by":"publisher","first-page":"3895","DOI":"10.1128\/AAC.02412-14","volume":"58","author":"A Carattoli","year":"2014","unstructured":"Carattoli A, Zankari E, Garc\u00eda-Fern\u00e1ndez A, Voldby Larsen M, Lund O, Villa L, et al. In silico detection and typing of plasmids using PlasmidFinder and plasmid multilocus sequence typing. Antimicrob Agents Chemother. 2014;58(7):3895\u2013903. https:\/\/doi.org\/10.1128\/AAC.02412-14.","journal-title":"Antimicrob Agents Chemother"},{"issue":"3","key":"5433_CR26","doi-asserted-by":"publisher","first-page":"e15","DOI":"10.1093\/nar\/gku1196","volume":"43","author":"NJ Croucher","year":"2015","unstructured":"Croucher NJ, Page AJ, Connor TR, Delaney AJ, Keane JA, Bentley SD, et al. Rapid phylogenetic analysis of large samples of recombinant bacterial whole genome sequences using Gubbins. Nucleic Acids Res. 2015;43(3):e15. https:\/\/doi.org\/10.1093\/nar\/gku1196.","journal-title":"Nucleic Acids Res"},{"issue":"5","key":"5433_CR27","doi-asserted-by":"publisher","first-page":"1530","DOI":"10.1093\/molbev\/msaa015","volume":"37","author":"BQ Minh","year":"2020","unstructured":"Minh BQ, Schmidt HA, Chernomor O, Schrempf D, Woodhams MD, von Haeseler A, et al. IQ-TREE 2: New Models and Efficient Methods for Phylogenetic Inference in the Genomic Era. Mol Biol Evol. 2020;37(5):1530\u20134. https:\/\/doi.org\/10.1093\/molbev\/msaa015.","journal-title":"Mol Biol Evol"},{"issue":"W1","key":"5433_CR28","doi-asserted-by":"publisher","first-page":"W293","DOI":"10.1093\/nar\/gkab301","volume":"49","author":"I Letunic","year":"2021","unstructured":"Letunic I, Bork P. Interactive Tree Of Life (iTOL) v5: an online tool for phylogenetic tree display and annotation. Nucleic Acids Res. 2021;49(W1):W293\u20136. https:\/\/doi.org\/10.1093\/nar\/gkab301.","journal-title":"Nucleic Acids Res"},{"issue":"3","key":"5433_CR29","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1016\/S0022-2836(05)80360-2","volume":"215","author":"SF Altschul","year":"1990","unstructured":"Altschul SF, Gish W, Miller W, Myers EW, Lipman DJ. Basic local alignment search tool. J Mol Biol. 1990;215(3):403\u201310. https:\/\/doi.org\/10.1016\/S0022-2836(05)80360-2.","journal-title":"J Mol Biol"},{"key":"5433_CR30","doi-asserted-by":"publisher","first-page":"402","DOI":"10.1186\/1471-2164-12-402","volume":"12","author":"NF Alikhan","year":"2011","unstructured":"Alikhan NF, Petty NK, Ben Zakour NL, Beatson SA. BLAST Ring Image Generator (BRIG): simple prokaryote genome comparisons. BMC Genomics. 2011;12:402. https:\/\/doi.org\/10.1186\/1471-2164-12-402.","journal-title":"BMC Genomics"},{"issue":"4","key":"5433_CR31","doi-asserted-by":"publisher","first-page":"637","DOI":"10.1093\/infdis\/jiy534","volume":"219","author":"PF Hsieh","year":"2019","unstructured":"Hsieh PF, Lu YR, Lin TL, Lai LY, Wang JT. Klebsiella pneumoniae Type VI Secretion System Contributes to Bacterial Competition, Cell Invasion, Type-1 Fimbriae Expression, and In Vivo Colonization. J Infect Dis. 2019;219(4):637\u201347. https:\/\/doi.org\/10.1093\/infdis\/jiy534.","journal-title":"J Infect Dis"},{"issue":"12","key":"5433_CR32","doi-asserted-by":"publisher","first-page":"6744","DOI":"10.1128\/IAI.68.12.6744-6749.2000","volume":"68","author":"H Sahly","year":"2000","unstructured":"Sahly H, Podschun R, Oelschlaeger TA, Greiwe M, Parolis H, Hasty D, et al. Capsule Impedes Adhesion to and Invasion of Epithelial Cells by Klebsiella pneumoniae. Infect Immun. 2000;68(12):6744\u20139. https:\/\/doi.org\/10.1128\/IAI.68.12.6744-6749.2000.","journal-title":"Infect Immun"},{"issue":"6","key":"5433_CR33","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.ppat.1007848","volume":"15","author":"L Deng","year":"2019","unstructured":"Deng L, Spencer BL, Holmes JA, Mu R, Rego S, Weston TA, et al. The Group B Streptococcal surface antigen I\/II protein, BspC, interacts with host vimentin to promote adherence to brain endothelium and inflammation during the pathogenesis of meningitis. PLoS Pathog. 2019;15(6):1\u201330. https:\/\/doi.org\/10.1371\/journal.ppat.1007848.","journal-title":"PLoS Pathog"},{"issue":"1","key":"5433_CR34","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1080\/21505594.2017.1421894","volume":"9","author":"X Wang","year":"2018","unstructured":"Wang X, Xie Y, Li G, Liu J, Li X, Tian L, et al. Whole-Genome-Sequencing characterization of bloodstream infection-causing hypervirulent Klebsiella pneumoniae of capsular serotype K2 and ST374. Virulence. 2018;9(1):510\u201321. https:\/\/doi.org\/10.1080\/21505594.2017.1421894.","journal-title":"Virulence"},{"issue":"5","key":"5433_CR35","doi-asserted-by":"publisher","first-page":"1233","DOI":"10.1093\/jac\/dkz023","volume":"74","author":"Y Liu","year":"2019","unstructured":"Liu Y, Long D, Xiang TX, Du FL, Wei DD, Wan LG, et al. Whole genome assembly and functional portrait of hypervirulent extensively drug-resistant NDM-1 and KPC-2 co-producing Klebsiella pneumoniae of capsular serotype K2 and ST86. J Antimicrob Chemother. 2019;74(5):1233\u201340. https:\/\/doi.org\/10.1093\/jac\/dkz023.","journal-title":"J Antimicrob Chemother"},{"issue":"8","key":"5433_CR36","doi-asserted-by":"publisher","first-page":"1194","DOI":"10.1016\/j.molp.2020.06.009","volume":"13","author":"C Chen","year":"2020","unstructured":"Chen C, Chen H, Zhang Y, Thomas HR, Frank MH, He Y, et al. TBtools: An Integrative Toolkit Developed for Interactive Analyses of Big Biological Data. Mol Plant. 2020;13(8):1194\u2013202. https:\/\/doi.org\/10.1016\/j.molp.2020.06.009.","journal-title":"Mol Plant"},{"issue":"4","key":"5433_CR37","doi-asserted-by":"publisher","first-page":"772","DOI":"10.1093\/molbev\/mst010","volume":"30","author":"K Katoh","year":"2013","unstructured":"Katoh K, Standley DM. MAFFT multiple sequence alignment software version 7: improvements in performance and usability. Mol Biol Evol. 2013;30(4):772\u201380. https:\/\/doi.org\/10.1093\/molbev\/mst010.","journal-title":"Mol Biol Evol"},{"key":"5433_CR38","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fmicb.2021.702956","volume":"12","author":"J Chen","year":"2021","unstructured":"Chen J, Zeng Y, Zhang R, Cai J. In vivo Emergence of Colistin and Tigecycline Resistance in Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae During Antibiotics Treatment. Front Microbiol. 2021;12:1\u20138. https:\/\/doi.org\/10.3389\/fmicb.2021.702956.","journal-title":"Front Microbiol"},{"key":"5433_CR39","doi-asserted-by":"publisher","first-page":"925440","DOI":"10.3389\/fcimb.2022.925440","volume":"12","author":"J Li","year":"2022","unstructured":"Li J, Ren J, Wang W, Wang G, Gu G, Wu X, et al. Molecular and clinical characterization of hypervirulent Klebsiella pneumoniae isolates from individuals with urinary tract infections. Front Cell Infect Microbiol. 2022;12:925440. https:\/\/doi.org\/10.3389\/fcimb.2022.925440.","journal-title":"Front Cell Infect Microbiol"},{"key":"5433_CR40","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.jhin.2023.02.005","volume":"134","author":"H Namikawa","year":"2023","unstructured":"Namikawa H, Oinuma KI, Yamada K, Kaneko Y, Kakeya H, Shuto T. Predictors of hypervirulent Klebsiella pneumoniae infections: a systematic review and meta-analysis. J Hosp Infect. 2023;134:153\u201360. https:\/\/doi.org\/10.1016\/j.jhin.2023.02.005.","journal-title":"J Hosp Infect"},{"issue":"9","key":"5433_CR41","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1128\/JCM.00776-18","volume":"56","author":"TA Russo","year":"2018","unstructured":"Russo TA, Olson R, Fang CT, Stoesser N, Miller M, MacDonald U, et al. Identification of Biomarkers for Differentiation of Hypervirulent Klebsiella pneumoniae from Classical K. pneumoniae. J Clin Microbiol. 2018;56(9):1\u201312. https:\/\/doi.org\/10.1128\/JCM.00776-18.","journal-title":"J Clin Microbiol"},{"issue":"2","key":"5433_CR42","doi-asserted-by":"publisher","first-page":"e02867","DOI":"10.1128\/mbio.02867-23","volume":"15","author":"TA Russo","year":"2024","unstructured":"Russo TA, Alvarado CL, Davies CJ, Drayer ZJ, Carlino-MacDonald U, Hutson A, et al. Differentiation of hypervirulent and classical Klebsiella pneumoniae with acquired drug resistance. mBio. 2024;15(2):e02867\u201323. https:\/\/doi.org\/10.1128\/mbio.02867-23.","journal-title":"mBio"},{"key":"5433_CR43","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1186\/s13073-018-0587-5","volume":"10","author":"MMC Lam","year":"2018","unstructured":"Lam MMC, Wyres KL, Wick RR, Judd LM, Fostervold A, Holt KE, et al. Tracking key virulence loci encoding aerobactin and salmochelin siderophore synthesis in Klebsiella pneumoniae. Genome Med. 2018;10:77. https:\/\/doi.org\/10.1186\/s13073-018-0587-5.","journal-title":"Genome Med"},{"key":"5433_CR44","doi-asserted-by":"publisher","first-page":"914884","DOI":"10.3389\/fmicb.2022.914884","volume":"13","author":"X Yang","year":"2022","unstructured":"Yang X, Liu X, Xu Y, Yang C, Chan EW-C, Shum HP, et al. Genetic and Functional Characterization of a Conjugative KpVP-2-Type Virulence Plasmid From a Clinical Klebsiella pneumoniae Strain. Front Microbiol. 2022;13:914884. https:\/\/doi.org\/10.3389\/fmicb.2022.914884.","journal-title":"Front Microbiol"},{"key":"5433_CR45","doi-asserted-by":"publisher","first-page":"19025","DOI":"10.1038\/s41598-023-46221-w","volume":"13","author":"B Neumann","year":"2023","unstructured":"Neumann B, St\u00fcrhof C, Rath A, Kieninger B, Eger E, M\u00fcller JU, et al. Detection and characterization of putative hypervirulent Klebsiella pneumoniae isolates in microbiological diagnostics. Sci Rep. 2023;13:19025. https:\/\/doi.org\/10.1038\/s41598-023-46221-w.","journal-title":"Sci Rep"},{"issue":"4","key":"5433_CR46","doi-asserted-by":"publisher","first-page":"1199","DOI":"10.1016\/j.bbrc.2005.03.097","volume":"330","author":"S Shin","year":"2005","unstructured":"Shin S, Lu G, Cai M, Kim KS. Escherichia coli outer membrane protein A adheres to human brain microvascular endothelial cells. Biochem Biophys Res Commun. 2005;330(4):1199\u2013204. https:\/\/doi.org\/10.1016\/j.bbrc.2005.03.097.","journal-title":"Biochem Biophys Res Commun"},{"key":"5433_CR47","doi-asserted-by":"publisher","first-page":"641","DOI":"10.2147\/IDR.S191892","volume":"12","author":"M Xu","year":"2019","unstructured":"Xu M, Fu Y, Fang Y, Xu H, Kong H, Liu Y, et al. High prevalence of KPC-2-producing hypervirulent Klebsiella pneumoniae causing meningitis in Eastern China. Infect Drug Resist. 2019;12:641\u201353. https:\/\/doi.org\/10.2147\/IDR.S191892.","journal-title":"Infect Drug Resist"},{"key":"5433_CR48","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fcimb.2017.00483","volume":"7","author":"CR Lee","year":"2017","unstructured":"Lee CR, Lee JH, Park KS, Jeon JH, Kim YB, Cha CJ, et al. Antimicrobial Resistance of Hypervirulent Klebsiella pneumoniae: Epidemiology, Hypervirulence-Associated Determinants, and Resistance Mechanisms. Front Cell Infect Microbiol. 2017;7:1\u201313. https:\/\/doi.org\/10.3389\/fcimb.2017.00483.","journal-title":"Front Cell Infect Microbiol"},{"issue":"10","key":"5433_CR49","doi-asserted-by":"publisher","first-page":"2509","DOI":"10.1093\/jac\/dkae248","volume":"79","author":"X Zhou","year":"2024","unstructured":"Zhou X, Yang M, Chen F, Wang L, Han P, Jiang Z, et al. Prediction of antimicrobial resistance in Klebsiella pneumoniae using genomic and metagenomic next-generation sequencing data. J Antimicrob Chemother. 2024;79(10):2509\u201317. https:\/\/doi.org\/10.1093\/jac\/dkae248.","journal-title":"J Antimicrob Chemother"},{"issue":"1","key":"5433_CR50","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/jacamr\/dlaf013","volume":"7","author":"ML Bixby","year":"2025","unstructured":"Bixby ML, Collins LB, Daley EC, Salay JM, Oliver S, Bryson AL, et al. Heteroresistance associated with the production of fosfomycin-resistant inner colonies during disk diffusion testing among a geographically diverse collection of Klebsiella pneumoniae clinical isolates. JAC-Antimicrobial Resist. 2025;7(1):1\u20138. https:\/\/doi.org\/10.1093\/jacamr\/dlaf013.","journal-title":"JAC-Antimicrobial Resist"},{"key":"5433_CR51","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1038\/s42003-021-02148-4","volume":"4","author":"M Xie","year":"2021","unstructured":"Xie M, Yang X, Xu Q, Ye L, Chen K, Zheng Z, et al. Clinical evolution of ST11 carbapenem resistant and hypervirulent Klebsiella pneumoniae. Commun Biology. 2021;4:650. https:\/\/doi.org\/10.1038\/s42003-021-02148-4.","journal-title":"Commun Biology"},{"key":"5433_CR52","doi-asserted-by":"publisher","first-page":"1133590","DOI":"10.3389\/fmicb.2023.1133590","volume":"14","author":"C Wu","year":"2023","unstructured":"Wu C, Zhou Y, Ai W, Guo Y, Wu X, Wang B, et al. Co-occurrence of OXA-232, RmtF-encoding plasmids, and pLVPK-like virulence plasmid contributed to the generation of ST15-KL112 hypervirulent multidrug-resistant Klebsiella pneumoniae. Front Microbiol. 2023;14:1133590. https:\/\/doi.org\/10.3389\/fmicb.2023.1133590.","journal-title":"Front Microbiol"},{"issue":"11","key":"5433_CR53","doi-asserted-by":"publisher","first-page":"2246","DOI":"10.3201\/eid2911.230463","volume":"29","author":"Y Wu","year":"2023","unstructured":"Wu Y, Jiang T, He X, Shao J, Wu C, Mao W, et al. Global Phylogeography and Genomic Epidemiology of Carbapenem-Resistant blaOXA\u2013232-Carrying Klebsiella pneumoniae Sequence Type 15 Lineage. Emerg Infect Dis. 2023;29(11):2246\u201356. https:\/\/doi.org\/10.3201\/eid2911.230463.","journal-title":"Emerg Infect Dis"},{"issue":"12","key":"5433_CR54","doi-asserted-by":"publisher","first-page":"3317","DOI":"10.1093\/jac\/dky358","volume":"73","author":"N Dong","year":"2018","unstructured":"Dong N, Lin D, Zhang R, Chan EW-C, Chen S. Carriage of blaKPC-2 by a virulence plasmid in hypervirulent Klebsiella pneumoniae. J Antimicrob Chemother. 2018;73(12):3317\u201321. https:\/\/doi.org\/10.1093\/jac\/dky358.","journal-title":"J Antimicrob Chemother"},{"issue":"3","key":"5433_CR55","doi-asserted-by":"publisher","first-page":"e02273","DOI":"10.1128\/AAC.02273-18","volume":"63","author":"D Shen","year":"2019","unstructured":"Shen D, Ma G, Li C, Jia X, Qin C, Yang T, et al. Emergence of a multidrug-resistant hypervirulent Klebsiella pneumoniae sequence type 23 strain with a rare blaCTX-M-24-harboring virulence plasmid. Antimicrob Agents Chemother. 2019;63(3):e02273\u201318. https:\/\/doi.org\/10.1128\/AAC.02273-18.","journal-title":"Antimicrob Agents Chemother"},{"issue":"4","key":"5433_CR56","doi-asserted-by":"publisher","first-page":"328","DOI":"10.1080\/20477724.2022.2121362","volume":"117","author":"G Arcari","year":"2023","unstructured":"Arcari G, Carattoli A. Global spread and evolutionary convergence of multidrug-resistant and hypervirulent Klebsiella pneumoniae high-risk clones. Pathogens Global Health. 2023;117(4):328\u201341. https:\/\/doi.org\/10.1080\/20477724.2022.2121362.","journal-title":"Pathogens Global Health"}],"container-title":["BMC Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12866-026-05433-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12866-026-05433-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12866-026-05433-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T09:16:07Z","timestamp":1789031767000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12866-026-05433-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,22]]},"references-count":56,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["5433"],"URL":"https:\/\/doi.org\/10.1186\/s12866-026-05433-6","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-9398214\/v1","asserted-by":"object"}]},"ISSN":["1471-2180"],"issn-type":[{"value":"1471-2180","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,22]]},"assertion":[{"value":"13 April 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 July 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Informed consent was obtained from the patient in the study. The protocol was reviewed by the Ethics Committee (IRB) of the Second Affiliated Hospital of Zhejiang Chinese Medical University. As this was an observational study and strains cultured from residual samples were used in clinical diagnosis, the confidentiality of patient data is preserved and compliance with the Declaration of Helsinki is ensured. After consulting the IRB of the Second Affiliated Hospital of Zhejiang Chinese Medical University, a formal ethical review approval was obtained (ethical approval no.: Y2026-038-01).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent for publication of patient clinical details and clinical images was obtained from the patient.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"798"}}