{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T18:38:58Z","timestamp":1793039938963,"version":"4.5.0"},"reference-count":29,"publisher":"Walter de Gruyter GmbH","issue":"2","license":[{"start":{"date-parts":[[2021,1,5]],"date-time":"2021-01-05T00:00:00Z","timestamp":1609804800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Hypervirulent <jats:italic>Klebsiella pneumoniae<\/jats:italic> (hvKp) is an evolving pathotype with higher virulence than classical <jats:italic>K. pneumoniae<\/jats:italic> (cKp) and is characterized by community-acquired, multiple sites of infections and young and healthy hosts. hvKP infections were primarily found in East Asia and have been increasingly reported worldwide over the past few decades. To better understand the clinical challenges faced by China with hvKP, this review will provide a summary and discussion focused on recognizing hvKP strains and prevalence of antibiotic-resistant hypervirulent strains in China and the mechanisms of acquiring antimicrobial resistance. Compared with cKP, hvKP is likely to cause serious disseminated infections, leading to a higher mortality. However, sensitive and specific clinical microbiology laboratory tests are still not available. Given the limited published data due to the clinical difficulty in differentiating hvKP from cKP, extrapolation of the previous data may not be applicable for the management of hvKP. A consensus definition of hvKP is needed. Furthermore, an increasing number of reports have described hvKp strains with antimicrobial resistance acquisition, increasing the challenges for management of hvKP. China, as an epidemic country, is also facing these challenges. Quite a number of studies from China have reported antibiotic-resistant hvKP strains, including extended-spectrum \u03b2-lactamase (ESBL), and carbapenem-, tigecycline-, and colistin-resistant strains. hvKP infections, especially those of antimicrobial-resistant strains, pose to be a great threat for public health in China. Therefore, an immediate response to recognize the hypervirulent strains and provide optimal treatments, especially those with resistance determinants, is an urgent priority for China.<\/jats:p>","DOI":"10.2478\/jtim-2021-0004","type":"journal-article","created":{"date-parts":[[2021,1,12]],"date-time":"2021-01-12T23:20:38Z","timestamp":1610493638000},"page":"71-75","source":"Crossref","is-referenced-by-count":32,"title":["Clinical challenges with hypervirulent <i>Klebsiella pneumoniae<\/i> (hvKP) in China"],"prefix":"10.2478","volume":"9","author":[{"given":"Yanzhu","family":"Chen","sequence":"first","affiliation":[{"name":"Department of Intensive Care Unit , Binhaiwan Central Hospital of Dongguan , Dongguan City , Guangdong Province , China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Intensive Care Unit , Binhaiwan Central Hospital of Dongguan , Dongguan City , Guangdong Province , China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2021,1,5]]},"reference":[{"key":"2023042508105395828_j_jtim-2021-0004_ref_001","doi-asserted-by":"crossref","unstructured":"Zhang Y, Zhao C, Wang Q, Wang X, Chen H, Li H, et al. High Prevalence of Hypervirulent Klebsiella pneumoniae Infection in China: Geographic Distribution, Clinical Characteristics, and Antimicrobial Resistance. Antimicrob Agents Chemother 2016; 60: 6115\u201320.","DOI":"10.1128\/AAC.01127-16"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_002","doi-asserted-by":"crossref","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: 483.","DOI":"10.3389\/fcimb.2017.00483"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_003","doi-asserted-by":"crossref","unstructured":"Chang L, Bastian I, Warner M. Survey of Klebsiella pneumoniae bacteraemia in two South Australian hospitals and detection of hypermucoviscous phenotype and magA\/rmpA genotypes in K. pneumoniae isolates. Infection 2013; 41: 559\u201363.","DOI":"10.1007\/s15010-012-0374-y"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_004","doi-asserted-by":"crossref","unstructured":"Russo TA, Marr CM. Hypervirulent Klebsiella pneumoniae. Clin Microbiol Rev 2019; 32: e00001\u201319.","DOI":"10.1128\/CMR.00001-19"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_005","doi-asserted-by":"crossref","unstructured":"Lin YT, Siu LK, Lin JC, Chen TL, Tseng CP, Yeh KM, et al. Seroepidemiology of Klebsiella pneumoniae colonizing the intestinal tract of healthy Chinese and overseas Chinese adults in Asian countries. BMC Microbiol 2012; 12: 13.","DOI":"10.1186\/1471-2180-12-13"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_006","doi-asserted-by":"crossref","unstructured":"Namikawa H, Yamada K, Sakiyama A, Imoto W, Yamairi K, Shibata W, et al. Clinical characteristics of bacteremia caused by hypermucoviscous Klebsiella pneumoniae at a tertiary hospital. Diagn Microbiol Infect Dis 2019; 95: 84\u20138.","DOI":"10.1016\/j.diagmicrobio.2019.04.008"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_007","doi-asserted-by":"crossref","unstructured":"Gu D, Dong N, Zheng Z, Lin D, Huang M, Wang L, et al. A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study. Lancet Infect Dis 2018;18: 37\u201346.","DOI":"10.1016\/S1473-3099(17)30489-9"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_008","doi-asserted-by":"crossref","unstructured":"Gu DX, Huang YL, Ma JH, Zhou HW, Fang Y, Cai JC, et al. Detection of Colistin Resistance Gene mcr-1 in Hypervirulent Klebsiella pneumoniae and Escherichia coli Isolates from an Infant with Diarrhea in China. Antimicrob Agents Chemother 2016; 60: 5099\u2013100.","DOI":"10.1128\/AAC.00476-16"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_009","doi-asserted-by":"crossref","unstructured":"Yuan Y, Li Y, Wang G, Li C, Chang YF, Chen W, et al. blaNDM-5 carried by a hypervirulent Klebsiella pneumoniae with sequence type 29. Antimicrob Resist Infect Control 2019; 8: 140.","DOI":"10.1186\/s13756-019-0596-1"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_010","doi-asserted-by":"crossref","unstructured":"Dong N, Sun Q, Huang Y, Shu L, Ye L, Zhang R, et al. Evolution of Carbapenem-Resistant Serotype K1 Hypervirulent Klebsiella pneumoniae by Acquisition of blaVIM-1-Bearing Plasmid. Antimicrob Agents Chemother 2019; 63: e01056\u201319.","DOI":"10.1128\/AAC.01056-19"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_011","doi-asserted-by":"crossref","unstructured":"Zhao Y, Zhang X, Torres VVL, Liu H, Rocker A, Zhang Y, et al. An Outbreak of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Wenzhou, China. Front Public Health 2019; 7: 229.","DOI":"10.3389\/fpubh.2019.00229"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_012","doi-asserted-by":"crossref","unstructured":"Liu C, Guo J. Characteristics of ventilator-associated pneumonia due to hypervirulent Klebsiella pneumoniae genotype in genetic background for the elderly in two tertiary hospitals in China. Antimicrob Resist Infect Control 2018; 7: 95.","DOI":"10.1186\/s13756-018-0371-8"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_013","doi-asserted-by":"crossref","unstructured":"Li J, Huang ZY, Yu T, Tao XY, Hu YM, Wang HC, et al. Isolation and characterization of a sequence type 25 carbapenem-resistant hypervirulent Klebsiella pneumoniae from the mid-south region of China. BMC Microbiol 2019; 19: 219.","DOI":"10.1186\/s12866-019-1593-5"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_014","doi-asserted-by":"crossref","unstructured":"Lu Y, Feng Y, McNally A, Zong ZY. The Occurence of Colistin-Resistant Hypervirulent Klebsiella pneumoniae in China. Front Microbiol 2018; 9: 2568.","DOI":"10.3389\/fmicb.2018.02568"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_015","doi-asserted-by":"crossref","unstructured":"Liu Y, Du FL, Xiang TX, Wan LG, Wei DD, Cao XW, et al. High Prevalence of Plasmid-Mediated Quinolone Resistance Determinants Among Serotype K1 Hypervirulent Klebsiella pneumoniae Isolates in China. Microb Drug Resist 2019; 25: 681\u20139.","DOI":"10.1089\/mdr.2018.0173"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_016","doi-asserted-by":"crossref","unstructured":"Liao W, Wang L, Li D, Du FL, Long D, Liu Y, et al. High Prevalence of 16s rRNA Methylase Genes Among Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae Isolates in a Chinese Tertiary Hospital. Microb Drug Resist 2020. Epub ahead of print.","DOI":"10.21203\/rs.2.14808\/v1"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_017","doi-asserted-by":"crossref","unstructured":"Xu M, Li A, Kong H, Zhang W, Chen H, Fu Y, et al. Endogenous endophthalmitis caused by a multidrug-resistant hypervirulent Klebsiella pneumoniae strain belonging to a novel single locus variant of ST23: first case report in China. BMC Infect Dis 2018; 18: 669.","DOI":"10.1186\/s12879-018-3543-5"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_018","doi-asserted-by":"crossref","unstructured":"Guo Y, Wang S, Zhan L, Jin Y, Duan J, Hao Z, et al. Microbiological and Clinical Characteristics of Hypermucoviscous Klebsiella pneumoniae Isolates Associated with Invasive Infections in China. Front Cell Infect Microbiol 2017; 7: 24.","DOI":"10.3389\/fcimb.2017.00024"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_019","doi-asserted-by":"crossref","unstructured":"Harada S, Doi Y. Hypervirulent Klebsiella pneumoniae: a Call for Consensus Definition and International Collaboration. J Clin Microbiol 2018; 56: e00959\u201318.","DOI":"10.1128\/JCM.00959-18"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_020","doi-asserted-by":"crossref","unstructured":"Liu C, Shi JJ, Guo J. High prevalence of hypervirulent Klebsiella pneumoniae infection in the genetic background of elderly patients in two teaching hospitals in China. Infect Drug Resist 2018;11:1031\u201341.","DOI":"10.2147\/IDR.S161075"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_021","doi-asserted-by":"crossref","unstructured":"Hao Z, Duan J, Liu L, Shen X, Yu J, Guo Y, et al. Prevalence of Community-Acquired, Hypervirulent Klebsiella pneumoniae Isolates in Wenzhou, China. Microb Drug Resist 2020; 26: 21\u20137.","DOI":"10.1089\/mdr.2019.0096"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_022","doi-asserted-by":"crossref","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: e00776\u201318.","DOI":"10.1128\/JCM.00776-18"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_023","doi-asserted-by":"crossref","unstructured":"Dong N, Yang XM, Zhang R, Chan WC, Chen S. Tracking microevolution events among ST11 carbapenemase-producing hypervirulent Klebsiella pneumoniae outbreak strains. Emerg Microbes Infect 2018; 7: 146.","DOI":"10.1038\/s41426-018-0146-6"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_024","doi-asserted-by":"crossref","unstructured":"Feng Y, Lu Y, Yao ZH, Zong ZY. Carbapenem-resistant hypervirulent Klebsiella pneumoniae of sequence type 36. Antimicrob Agents Chemother 2018; 62: e02644\u201317.","DOI":"10.1128\/AAC.02644-17"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_025","doi-asserted-by":"crossref","unstructured":"Cheng YH, Huang TW, Juan CH, Chou SH, Tseng YY, Chen TW, et al. Tigecycline-non-susceptible hypervirulent Klebsiella pneumoniae strains in Taiwan. J Antimicrob Chemother 2020; 75: 309\u201317.","DOI":"10.1093\/jac\/dkz450"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_026","doi-asserted-by":"crossref","unstructured":"Huang YH, Chou SH, Liang SW, Ni CE, Lin YT, Huang YW, et al. Emergence of an XDR and carbapenemase-producing hypervirulent Klebsiella pneumoniae strain in Taiwan. J Antimicrob Chemother 2018; 73: 2039\u201346.","DOI":"10.1093\/jac\/dky164"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_027","doi-asserted-by":"crossref","unstructured":"Boucher HW, Talbot GH, Bradley JS, Edwards JE, Gilbert D, Rice LB, et al. Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009; 48: 1\u201312.","DOI":"10.1086\/595011"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_028","doi-asserted-by":"crossref","unstructured":"Zhang R, Lin D, Chan EW, Gu D, Chen GX, Chen S. Emergence of carbapenem-resistant serotype K1 hypervirulent Klebsiella pneumoniae strains in China. Antimicrob Agents Chemother 2016; 60: 709\u201311.","DOI":"10.1128\/AAC.02173-15"},{"key":"2023042508105395828_j_jtim-2021-0004_ref_029","doi-asserted-by":"crossref","unstructured":"Turton JF, Payne Z, Coward A, Hopkins KL, Turton JA, Doumith M, et al. Virulence genes in isolates of Klebsiella pneumoniae from the UK during 2016, including among carbapenemase gene-positive hypervirulent K1-ST23 and \u2018non-hypervirulent\u2019 types ST147, ST15 and ST383. J Med Microbiol 2018; 67: 118\u201328.","DOI":"10.1099\/jmm.0.000653"}],"container-title":["Journal of Translational Internal Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/content.sciendo.com\/view\/journals\/jtim\/ahead-of-print\/article-10.2478-jtim-2021-0004\/article-10.2478-jtim-2021-0004.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.2478\/jtim-2021-0004\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.2478\/jtim-2021-0004\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,4,25]],"date-time":"2023-04-25T08:25:46Z","timestamp":1682411146000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.degruyter.com\/document\/doi\/10.2478\/jtim-2021-0004\/html"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,5]]},"references-count":29,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,1,29]]},"published-print":{"date-parts":[[2021,6,1]]}},"alternative-id":["10.2478\/jtim-2021-0004"],"URL":"https:\/\/doi.org\/10.2478\/jtim-2021-0004","relation":{},"ISSN":["2224-4018"],"issn-type":[{"value":"2224-4018","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,5]]}}}