Hypervirulent Klebsiella pneumoniae: Epidemiology outside Asian countries, antibiotic resistance association, methods of detection and clinical management

Two main Klebsiella pneumoniae pathotypes are of public health concern, classical K. pneumoniae (cKP), with high antibiotic resistance acquisition capacity, and hypervirulent K. pneumoniae (hvKP). The emergence of hypervirulent and antibiotic-resistant K. pneumoniae, especially carbapenem resistance, is worrisome and require effective methods for detection and treatment. Different evolutionary paths contribute to the emergence of hypervirulence and antibiotic resistance, commonly via the acquisition of resistance plasmids by hvKP (CR-hvKP) or the acquisition of virulence plasmids by CRKp (hv-CRKp). ST11-KL64 together with blaKPC-2, is the most extended hv-CRKP lineage acquiring virulence plasmids with associated biomarkers, rmpA, rmpa2, iroBCDEN, iucABCDiutA, and peg344. In addition to ST11, other hv-CRKP clones have been reported in Europe such as ST101, ST147 and ST512, highlighting the association of ST147 with OXA-48 and NDM carbapenemases. Although still very rare in Spain, hvKP cases are increasing in recent years, mainly due to ST23-K1, ST380-K2 and ST86-K2. Management of hvKP infections requires active antibiotic therapy based primarily on antibiotic susceptibility patters and site of infection.