{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T23:57:07Z","timestamp":1784159827552,"version":"3.55.0"},"reference-count":29,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T00:00:00Z","timestamp":1753833600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Invasive liver abscess syndrome (ILAS) caused by hypervirulent <jats:italic>Klebsiella pneumoniae<\/jats:italic> (hvKp) is a life-threatening infection associated with high mortality, particularly when complicated by brain abscesses. The emergence of carbapenem-resistant hypervirulent <jats:italic>K. pneumoniae<\/jats:italic> (CR-hvKp) during treatment, driven by emerging resistance, poses significant therapeutic challenges.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case presentation<\/jats:title><jats:p>We describe a 70-year-old diabetic male with recurrent ILAS who developed sequential multi-organ infections, including urinary tract infection, bacteremia, lung abscess, and brain abscess. Initial isolates were identified as carbapenem-susceptible; however, under prolonged antimicrobial pressure, they were transformed into CR-hvKp carrying the KPC gene. Treatment escalated from meropenem to ceftazidime-avibactam plus tigecycline, resulting in clinical improvement and discharge after 48\u202fdays.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>This case highlights the critical challenge of emerging resistance in hvKp during prolonged therapy, emphasizing the need for early molecular surveillance, multidisciplinary collaboration, and optimized antibiotic stewardship to mitigate treatment failure in ILAS.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1605284","type":"journal-article","created":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T05:30:09Z","timestamp":1753853409000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Recurrent invasive liver abscess syndrome induced by Klebsiella pneumoniae with emerging drug resistance: a case report and literature review"],"prefix":"10.3389","volume":"12","author":[{"given":"Yongmei","family":"Li","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zheng","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengjiao","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jialin","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chengcheng","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,7,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"881","DOI":"10.1016\/s1473-3099(12)70205-0","article-title":"Klebsiella pneumoniae liver abscess: a new invasive syndrome","volume":"12","author":"Siu","year":"2012","journal-title":"Lancet Infect Dis"},{"key":"ref2","first-page":"87","article-title":"Adult Klebsiella pneumoniae meningitis in Taiwan: an overview","volume":"21","author":"Chang","year":"2012","journal-title":"Acta Neurol Taiwanica"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1017\/s0950268897007930","article-title":"Klebsiella meningitis in Taiwan: an overview","volume":"119","author":"Tang","year":"1997","journal-title":"Epidemiol Infect"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1826","DOI":"10.1056\/NEJMp048246","article-title":"Bacterial meningitis--a view of the past 90 years","volume":"351","author":"Swartz","year":"2004","journal-title":"N Engl J Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"73","DOI":"10.3969\/j.issn.2096-3327.2024.11.012","article-title":"Updates in diagnosis and treatment of high virulent Klebsiella Pneumoniae infection","volume":"21","author":"He","year":"2024","journal-title":"Chin J Rational Drug Use"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"642484","DOI":"10.3389\/fmicb.2021.642484","article-title":"Virulence Factors in Hypervirulent Klebsiella pneumoniae","volume":"12","author":"Zhu","year":"2021","journal-title":"Front Microbiol"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1164","DOI":"10.3760\/cma.j.cn114452-20230925-00162","article-title":"Expert consensus on laboratory testing for hypervirulent Klebsiella pneumoniae","volume":"11","year":"2023","journal-title":"Chin J Lab Med"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1111\/joim.13007","article-title":"Hypervirulent Klebsiella pneumoniae - clinical and molecular perspectives","volume":"287","author":"Choby","year":"2020","journal-title":"J Intern Med"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1128\/cmr.00001-19","article-title":"Hypervirulent Klebsiella pneumoniae","volume":"32","author":"Russo","year":"2019","journal-title":"Clin Microbiol Rev"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"560","DOI":"10.3760\/cma.j.cn112309-20230801-00023","article-title":"Progress in the mechanisms of susceptibility to hypervirulent Klebsiella pneumoniae in diabetic patients","volume":"6","author":"Jiang","year":"2024","journal-title":"Chin J Microbiol Immunol"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"483","DOI":"10.3389\/fcimb.2017.00483","article-title":"Antimicrobial resistance of Hypervirulent Klebsiella pneumoniae: epidemiology, Hypervirulence-associated determinants, and resistance mechanisms","volume":"7","author":"Lee","year":"2017","journal-title":"Front Cell Infect Microbiol"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/s1473-3099(17)30489-9","article-title":"A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study","volume":"18","author":"Gu","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"ref13","volume-title":"Study on the resistance and pathogenic mechanisms of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) [Doctoral dissertation, Shandong University]","author":"Kang","year":"2020"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"6115","DOI":"10.1128\/aac.01127-16","article-title":"High prevalence of Hypervirulent Klebsiella pneumoniae infection in China: geographic distribution, clinical characteristics, and antimicrobial resistance","volume":"60","author":"Zhang","year":"2016","journal-title":"Antimicrob Agents Chemother"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1294","DOI":"10.1099\/mgen.0.001294","article-title":"Diversity, functional classification and genotyping of SHV \u03b2-lactamases in Klebsiella pneumoniae","volume":"10","author":"Tsang","year":"2024","journal-title":"Microb Genom"},{"key":"ref16","volume-title":"Performance standards for antimicrobial susceptibility testing","year":"2022"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"187","DOI":"10.1186\/s12866-020-01870-z","article-title":"Evaluation of the Etest and disk diffusion method for detection of the activity of ceftazidime-avibactam against Enterobacterales and Pseudomonas aeruginosa in China","volume":"20","author":"Wang","year":"2020","journal-title":"BMC Microbiol"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"531","DOI":"10.1093\/jac\/dkab380","article-title":"In vivo evolution of carbapenem resistance in hypervirulent Klebsiella pneumoniae in a patient undergoing long-term treatment","volume":"77","author":"Tang","year":"2022","journal-title":"J Antimicrob Chemother"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"372","DOI":"10.14309\/ajg.0000000000001610","article-title":"Klebsiella pneumoniae invasive syndrome with Ventriculitis","volume":"117","author":"Lee","year":"2022","journal-title":"Am J Gastroenterol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"991306","DOI":"10.3389\/fpubh.2022.991306","article-title":"Hypervirulent carbapenem-resistant Klebsiella pneumoniae causing highly fatal meningitis in southeastern China","volume":"10","author":"Huang","year":"2022","journal-title":"Front Public Health"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"641","DOI":"10.2147\/idr.S191892","article-title":"High prevalence of KPC-2-producing hypervirulent Klebsiella pneumoniae causing meningitis in eastern China","volume":"12","author":"Xu","year":"2019","journal-title":"Infect Drug Resist"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1080\/14787210.2018.1489722","article-title":"Anti-infective treatment of brain abscess","volume":"16","author":"Bodilsen","year":"2018","journal-title":"Expert Rev Anti-Infect Ther"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"447","DOI":"10.1056\/NEJMra1301635","article-title":"Brain abscess","volume":"371","author":"Brouwer","year":"2014","journal-title":"N Engl J Med"},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciae403","article-title":"Infectious Diseases Society of America 2024 guidance on the treatment of antimicrobial-resistant gram-negative infections","author":"Tamma","year":"2024","journal-title":"Clin Infect Dis"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"8896374","DOI":"10.1155\/2021\/8896379","article-title":"A rare case of recurrent Klebsiella pneumoniae liver abscess","volume":"2021","author":"Amoateng","year":"2021","journal-title":"Case Rep Infect Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"4371","DOI":"10.1128\/jcm.05658-11","article-title":"Recurring Klebsiella pneumoniae pyogenic liver abscesses in a resident of San Diego, California, due to a K1 strain carrying the virulence plasmid","volume":"49","author":"Fierer","year":"2011","journal-title":"J Clin Microbiol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"3336","DOI":"10.1128\/jcm.00918-09","article-title":"Recurrent Klebsiella pneumoniae liver abscess: clinical and microbiological characteristics","volume":"47","author":"Yang","year":"2009","journal-title":"J Clin Microbiol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"141","DOI":"10.1016\/j.jmii.2011.12.006","article-title":"Increasing opsonizing and killing effect of serum from patients with recurrent K1 Klebsiella pneumoniae liver abscess","volume":"45","author":"Yeh","year":"2012","journal-title":"J Microbiol Immunol Infect"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"1315","DOI":"10.1007\/s10096-020-03848-1","article-title":"The increased recurrence rate of liver abscess caused by extended-spectrum \u03b2-lactamase-producing Klebsiella pneumoniae","volume":"39","author":"Wang","year":"2020","journal-title":"Eur J Clin Microbiol Infect Dis"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1605284\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T05:30:12Z","timestamp":1753853412000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1605284\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,30]]},"references-count":29,"alternative-id":["10.3389\/fmed.2025.1605284"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1605284","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,30]]},"article-number":"1605284"}}