{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:37:05Z","timestamp":1790876225160,"version":"4.1.0"},"reference-count":26,"publisher":"Akademiai Kiado Zrt.","issue":"4","license":[{"start":{"date-parts":[[2022,12,6]],"date-time":"2022-12-06T00:00:00Z","timestamp":1670284800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMicr"],"published-print":{"date-parts":[[2022,12,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>This study focused on the characterization of 19 hypermucoviscous <jats:italic>Klebsiella pneumoniae<\/jats:italic> strains, that were identified from 26 hypermucosal strains. In order to identify hypermucoviscous strains of <jats:italic>K. pneumoniae<\/jats:italic>, the string test was applied. This phenotype is known in the literature as one of the virulence factors of this species together with the production of biofilm and other hypervirulence factor genes such as: <jats:italic>rmpA, rmpA2, iucA, iroB, peg-344<\/jats:italic>. We also investigated presence of <jats:italic>magA<\/jats:italic> gene that correlates with the hyper-production of capsule of K1 serotype. Of the strains under study, 13 out of 19 harboured at least one virulence factor.<\/jats:p><jats:p>Sequence type (ST) was determined in order to identify known high-risk clones or new emerging high-risk clones and their variability in a single clinical setting. Important STs found among these strains were ST65 and ST29. Carbapenem resistance was also investigated and 4 out of 19 strains harboured at least a carbapenemase: one strain harboured a KPC enzyme alone, one strain carried a KPC and an OXA-48 like, one strain produced OXA-48-like alone, and the last strain harboured two metallo-\u03b2-lactamases (VIM-1 and NDM-5) plus OXA-48-like. In particular, this latter strain belongs to ST383, which was recently reported in Northern Italy as a hypervirulent and XDR strain.<\/jats:p><jats:p>The global spread of hypervirulent <jats:italic>K. pneumoniae<\/jats:italic> is an important epidemiological issue that should be considered in diagnostic and therapeutic managements of patients with <jats:italic>K. pneumoniae<\/jats:italic> infections.<\/jats:p>","DOI":"10.1556\/030.2022.01908","type":"journal-article","created":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T10:01:36Z","timestamp":1713952896000},"page":"297-302","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":11,"title":["Multiple detection of hypermucoviscous and hypervirulent strains of Klebsiella pneumoniae: An emergent health care threat"],"prefix":"10.1556","volume":"69","author":[{"given":"Anna","family":"Ventura","sequence":"first","affiliation":[{"name":"Department of Diagnostics and Public Health, University of Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Addis","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Public Health, University of Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Bertoncelli","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Public Health, University of Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2729-1007","authenticated-orcid":true,"given":"Annarita","family":"Mazzariol","sequence":"additional","affiliation":[{"name":"Department of Diagnostics and Public Health, University of Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"key":"B1","series-title":"Risk assessment: emergence of hypervirulent Klebsiella pneumoniae ST23 carrying carbapenemase genes in EU\/EEA countries","author":"European Centre for Disease Prevention and Control","year":"March 2021","unstructured":"European Centre for Disease Prevention and Control. Risk assessment: emergence of hypervirulent Klebsiella pneumoniae ST23 carrying carbapenemase genes in EU\/EEA countries. ECDC website; March 2021."},{"key":"B2","series-title":"Clin Microbiol Rev","first-page":"629","article-title":"Klebsiella pneumoniae: going on the offense with a strong defense","volume":"80","author":"PaczosaMK","year":"2016","unstructured":"PaczosaMK, MecsasJ. Klebsiella pneumoniae: going on the offense with a strong defense. Clin Microbiol Rev 2016; 80: 629\u201361."},{"key":"B3","series-title":"Arch Intern Med","first-page":"1913","article-title":"Klebsiella pneumoniae liver abscess associated with septic endophthalmitis","volume":"146","author":"LiuYC","year":"1986","unstructured":"LiuYC, ChengDL, LinCL. Klebsiella pneumoniae liver abscess associated with septic endophthalmitis. Arch Intern Med 1986; 146: 1913\u201316."},{"key":"B4","series-title":"Clin Microbiol Rev","first-page":"e00001","article-title":"Hypervirulent Klebsiella pneumoniae","volume":"32","author":"RussoTA","year":"2019","unstructured":"RussoTA, MarrCM. Hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev 2019; 32: e00001\u201319."},{"key":"B5","series-title":"J Med Microbiol","first-page":"803","article-title":"magA is not a specific virulence gene for Klebsiella pneumoniae strains causing liver abscess but is part of the capsular polysaccharide gene cluster of K. pneumoniae serotype K1","volume":"55","author":"YehKM","year":"2006","unstructured":"YehKM, ChangFY, FungCF, LinJC, SiuLK. magA is not a specific virulence gene for Klebsiella pneumoniae strains causing liver abscess but is part of the capsular polysaccharide gene cluster of K. pneumoniae serotype K1. J Med Microbiol 2006; 55: 803\u20134."},{"key":"B6","series-title":"Infect Imm","first-page":"3325","article-title":"Aerobactin, but not yersiniabactin, salmochelin, or enterobactin, enables the growth\/survival of hypervirulent (hypermucoviscous) Klebsiella pneumoniae ex vivo and in vivo","volume":"83","author":"RussoTA","year":"2015","unstructured":"RussoTA, OlsonR, MacDonaldU, BeananJ, DavidsonBA. Aerobactin, but not yersiniabactin, salmochelin, or enterobactin, enables the growth\/survival of hypervirulent (hypermucoviscous) Klebsiella pneumoniae ex vivo and in vivo. Infect Imm 2015; 83: 3325\u201333."},{"key":"B7","series-title":"Ped Infec Dis J","first-page":"1002","article-title":"Klebsiella pneumoniae: virulence, biofilm and antimicrobial resistance","volume":"36","author":"PiperakiET","year":"2017","unstructured":"PiperakiET, SyrogiannopoulosGA, TzouvelekisLS, DaikosGL. Klebsiella pneumoniae: virulence, biofilm and antimicrobial resistance. Ped Infec Dis J 2017; 36: 1002\u20135."},{"key":"B8","unstructured":"https:\/\/www.eucast.org\/clinical_breakpoints."},{"key":"B9","series-title":"Eur J Clin Microbiol Infect Dis","first-page":"981","article-title":"Clinical and phenotypic differences between classic and hypervirulent Klebsiella pneumoniae: an emerging and under-recognized pathogenic variant","volume":"31","author":"PomakovaDK","year":"2012","unstructured":"PomakovaDK, HsiaoCB, BeananJM, OlsonR, MacDonaldU, KeynanY, et al. Clinical and phenotypic differences between classic and hypervirulent Klebsiella pneumoniae: an emerging and under-recognized pathogenic variant. Eur J Clin Microbiol Infect Dis 2012; 31: 981\u20139."},{"key":"B10","series-title":"Virulence","first-page":"1111","article-title":"Hypervirulence and hypermucoviscosity: two different but complementary Klebsiella spp. Phenotypes?","volume":"8","author":"Catal\u00e1n-N\u00e1jeraJC","year":"2017","unstructured":"Catal\u00e1n-N\u00e1jeraJC, Garza-RamosU, Barrios-CamachoH. Hypervirulence and hypermucoviscosity: two different but complementary Klebsiella spp. Phenotypes? Virulence 2017; 8: 1111\u201323."},{"key":"B11","series-title":"Curr Opin Microbiol","first-page":"95","article-title":"The intersection of capsule gene expression, hypermucoviscosity and hypervirulence in Klebsiella pneumoniae","volume":"54","author":"WalkerKA","year":"2020","unstructured":"WalkerKA, MillerVL. The intersection of capsule gene expression, hypermucoviscosity and hypervirulence in Klebsiella pneumoniae. Curr Opin Microbiol 2020; 54: 95\u2013102."},{"key":"B12","series-title":"Sci Rep","article-title":"K-PAM: a unified platform to distinguish Klebsiella species K- and O-antigen types, model antigen structures and identify hypervirulent strains","volume":"10","author":"PatroLPP","year":"2020","unstructured":"PatroLPP, SudhakarKU, RathinavelanT. K-PAM: a unified platform to distinguish Klebsiella species K- and O-antigen types, model antigen structures and identify hypervirulent strains. Sci Rep 2020; 10: 16372."},{"key":"B13","series-title":"J Clin Microbiol","first-page":"466","article-title":"Capsular serotype K1 or K2, rather than magA and rmpA, is a major virulence determinant for Klebsiella pneumoniae liver abscess in Singapore and Taiwan","volume":"45","author":"YehKM","year":"2007","unstructured":"YehKM, KurupA, SiuLK, KohYL, FungCP, LinJC, et al. Capsular serotype K1 or K2, rather than magA and rmpA, is a major virulence determinant for Klebsiella pneumoniae liver abscess in Singapore and Taiwan. J Clin Microbiol 2007; 45: 466\u201371."},{"key":"B14","series-title":"Emerg Infect Dis","first-page":"1503","article-title":"Rapid detection of carbapenemase-producing Enterobacteriaceae","volume":"18","author":"NordmannP","year":"2012","unstructured":"NordmannP, PoirelL, DortetL. Rapid detection of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis 2012; 18: 1503\u20137."},{"key":"B15","series-title":"J Antimicrob Chemother","first-page":"490","article-title":"Development of a set of multiplex PCR assays for the detection of genes encoding important b-lactamases in Enterobacteriaceae","volume":"65","author":"DallenneC","year":"2010","unstructured":"DallenneC, Da CostaA, DecreD, FavierC, ArletG. Development of a set of multiplex PCR assays for the detection of genes encoding important b-lactamases in Enterobacteriaceae. J Antimicrob Chemother 2010; 65: 490\u20135."},{"key":"B16","unstructured":"http:\/\/www.pasteur.fr\/mlst"},{"key":"B17","series-title":"J Clin Microbiol","first-page":"4178","article-title":"Multilocus sequence typing of Klebsiella pneumoniae nosocomial isolates","volume":"43","author":"DiancourtL","year":"2005","unstructured":"DiancourtL, PassetV, VerhoefJ, GrimontPAD, BrisseS. Multilocus sequence typing of Klebsiella pneumoniae nosocomial isolates. J Clin Microbiol 2005; 43: 4178\u201382."},{"key":"B18","series-title":"J Pathol Microbiol Immunol","first-page":"891","article-title":"Quantification of biofilm in microtiter plates: overview of testing conditions and practical recommendations for assessment of biofilm production by staphylococci","volume":"115","author":"Stepanovi\u0107S","year":"2007","unstructured":"Stepanovi\u0107S, Vukovi\u0107D, HolaV, Di BonaventuraG, Djuki\u0107S, Cirkovi\u0107I, et al. Quantification of biofilm in microtiter plates: overview of testing conditions and practical recommendations for assessment of biofilm production by staphylococci. J Pathol Microbiol Immunol 2007; 115: 891\u20139."},{"key":"B19","series-title":"Acute Med Surg","first-page":"245","article-title":"Clinical utility of string test as a screening method for hypermucoviscosity-phenotype Klebsiella pneumoniae","volume":"1","author":"HagiyaH","year":"2014","unstructured":"HagiyaH, WatanabeN, MakiM, MuraseT, OtsukaF. Clinical utility of string test as a screening method for hypermucoviscosity-phenotype Klebsiella pneumoniae. Acute Med Surg 2014; 1: 245\u20136."},{"key":"B20","series-title":"Diagn Microbiol Infec Dis","article-title":"Molecular epidemiology of NDM-5-producing Escherichia coli high-risk clones identified in two Italian hospitals in 2017-2019","volume":"100","author":"BibbolinoG","year":"2021","unstructured":"BibbolinoG, Di LellaFM, OlivaA, LichtnerM, Del BorgoC, RaponiG, et al. Molecular epidemiology of NDM-5-producing Escherichia coli high-risk clones identified in two Italian hospitals in 2017-2019. Diagn Microbiol Infec Dis 2021; 100: 115399."},{"key":"B21","series-title":"Microbiol Spectr","first-page":"e01305","article-title":"Emergence of tigecycline nonsusceptible and IMP-4 carbapenemase-producing K2-ST65 hypervirulent Klebsiella pneumoniae in China","volume":"9","author":"ZhangY","year":"2021","unstructured":"ZhangY, WangX, WangQ, ChenH, LiH, WangS, et al. Emergence of tigecycline nonsusceptible and IMP-4 carbapenemase-producing K2-ST65 hypervirulent Klebsiella pneumoniae in China. Microbiol Spectr 2021; 9: e01305-21."},{"key":"B22","series-title":"Front Microbiol","article-title":"KPC-2-producing carbapenem-resistant Klebsiella pneumoniae of the uncommon ST29 type carrying OXA-926, a novel narrow-spectrum OXA \u03b2-lactamase","volume":"12","author":"LiuL","year":"2021","unstructured":"LiuL, FengL, WeiL, XiaoY, ZongZ. KPC-2-producing carbapenem-resistant Klebsiella pneumoniae of the uncommon ST29 type carrying OXA-926, a novel narrow-spectrum OXA \u03b2-lactamase. Front Microbiol 2021; 12: 701513."},{"key":"B23","series-title":"Infec Drug Res","first-page":"2237","article-title":"The first case of community-acquired pneumonia due to capsular genotype K2-ST86 hypervirulent Klebsiella pneumoniae in Okinawa, Japan: a case report and literature review","volume":"13","author":"HiraiJ","year":"2020","unstructured":"HiraiJ, SakanashiD, KinjoT, HaranagaS, FujitaJ. The first case of community-acquired pneumonia due to capsular genotype K2-ST86 hypervirulent Klebsiella pneumoniae in Okinawa, Japan: a case report and literature review. Infec Drug Res 2020; 13: 2237\u201343."},{"key":"B24","series-title":"Med Mal Infec","first-page":"171","article-title":"Seven hypervirulent ST380 Klebsiella pneumoniae septic localizations","volume":"47","author":"HentzienM","year":"2017","unstructured":"HentzienM, RosmanJ, Decr\u00e9D, BrenkleK, Mendes-MartinsL, MateuP. Seven hypervirulent ST380 Klebsiella pneumoniae septic localizations. Med Mal Infec 2017; 47: 171\u20133."},{"key":"B25","series-title":"J Glob Antimicrob Resist","first-page":"146","article-title":"Detection of NDM-1\/5 and OXA-48 co-producing extensively drug-resistant hypervirulent Klebsiella pneumoniae in Northern Italy","volume":"28","author":"LorenzinG","year":"2022","unstructured":"LorenzinG, GonaF, BattagliaS, SpitaleriA, SaluzzoF, TrovatoA, et al. Detection of NDM-1\/5 and OXA-48 co-producing extensively drug-resistant hypervirulent Klebsiella pneumoniae in Northern Italy. J Glob Antimicrob Resist 2022; 28: 146\u201350."},{"key":"B26","series-title":"Ann Clin Microbiol and Antimicrob","first-page":"24","article-title":"Emerging high-risk ST101 and ST307 carbapenem-resistant Klebsiella pneumoniae clones from bloodstream infections in Southern Italy","volume":"19","author":"LoconsoleD","year":"2020","unstructured":"LoconsoleD, AccogliM, De RobertisAL, CapozziL, BiancoA, MoreaA, et al. Emerging high-risk ST101 and ST307 carbapenem-resistant Klebsiella pneumoniae clones from bloodstream infections in Southern Italy. Ann Clin Microbiol and Antimicrob 2020; 19: 24."}],"container-title":["Acta Microbiologica et Immunologica Hungarica"],"original-title":[],"link":[{"URL":"https:\/\/akjournals.com\/view\/journals\/030\/69\/4\/article-p297.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/akjournals.com\/downloadpdf\/journals\/030\/69\/4\/article-p297.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/akjournals.com\/downloadpdf\/journals\/030\/69\/4\/article-p297.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,24]],"date-time":"2024-04-24T10:01:36Z","timestamp":1713952896000},"score":1,"resource":{"primary":{"URL":"https:\/\/akjournals.com\/view\/journals\/030\/69\/4\/article-p297.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,6]]},"references-count":26,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.1556\/030.2022.01908","relation":{},"ISSN":["1217-8950","1588-2640"],"issn-type":[{"value":"1217-8950","type":"print"},{"value":"1588-2640","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,6]]}}}