Virulence and Resistance of Klebsiella pneumoniae, 2nd Edition

A special issue of Microorganisms (ISSN 2076-2607). This special issue belongs to the section "Medical Microbiology".

Deadline for manuscript submissions: closed (15 April 2025) | Viewed by 15326

Special Issue Editors


E-Mail Website
Guest Editor
1. Faculdade de Farmacia, Universidade de Lisboa, Department of Microbiology and Immunology, Lisbon, Portugal
2. Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
Interests: biochemistry, environmental exposures; microbiology; antibiotics; bacterial virulence
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
1. Microbiology Research Laboratory in Environmental Health (EnviHealthMicro Lab), Institute of Environmental Health (ISAMB), Faculty of Medicine, University of Lisboa, 1649-026 Lisboa, Portugal
2. Institute of Preventive Medicine and Public Health (IMP&SP), University of Lisboa, 1649-026 Lisboa, Portugal
3. Microbiology and Immunology Department, Faculty of Pharmacy, University of Lisboa, 1649-033 Lisboa, Portugal
4. Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Universitário Egas Moniz (IUEM), Caparica, Portugal
Interests: klebsiella pneumoniae complex; gram-negative pathogens; enterobacteriacea; virulence factors; antimicrobial resistance; extended-spectrum β-lactamases (ESBL); carbapenemases; home care services; quality of health care; respiratory diseases; pulmonary rehabilitation; oxygen; non-invasive ventilation; sleep care; e-health
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

This Special Issue is the continuation of our previous special issue "Virulence and Resistance of Klebsiella pneumonia".

Klebsiella pneumoniae is an important opportunistic Gram-negative pathogen that belongs to the Enterobacteriaceae family, which is frequently associated with severe healthcare-associated infections (HAI) as well as community-acquired infections. It can cause different types of infection such as pneumonia, urinary tract infection, skin or soft tissue infection, meningitis, pyogenic liver abscess, and bacteremia potentially developing into sepsis. It is believed that the gastrointestinal tract is the most important reservoir for the transmission of K. pneumoniae. However, in contrast to many other bacterial pathogens, K. pneumoniae is ubiquitous in nature, and environmental reservoirs can also have a relevant role in human infections. Infections resulting from multidrug-resistant (MDR), extended-spectrum beta-lactamase (ESBL), and/or carbapenemase-producing K. pneumoniae strains are a challenge due to the lack of vaccines and therapeutic options. Several virulence factors, such as adherence and invasion factors, toxins, capsules, and siderophores, can be involved in the pathogenic mechanisms, namely, invasion of the host, disease induction, and the evasion of host defenses. The coexistence of antimicrobial resistance genes with other advantageous determinants such as virulence factors can have a significant impact on bacterial pathogenicity. Moreover, recent population diversity studies have shown that K. pneumoniae is in fact part of a complex of species. The aim of this Special Issue is to give an updated insight into K. pneumonia-complex resistance and virulence determinants, and the interplay of these factors. For this purpose, we welcome the submission of research articles, review articles, and short communications related to the various aspects of K. pneumonia-complex infection, with particular emphasis on antimicrobial resistance, its transmissibility, molecular pathways, the coexistence of virulence factors, biomarkers, clinical and environmental reservoirs, high-risk clones, whole genome sequencing characterization, in vivo infection models, and bacterial pathogenicity.

Dr. Aida Duarte
Dr. Cátia Caneiras
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Microorganisms is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Benefits of Publishing in a Special Issue

  • Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
  • Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
  • External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
  • e-Book format: Special Issues with more than 10 articles can be published as dedicated e-books, ensuring wide and rapid dissemination.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (6 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Jump to: Review

15 pages, 2960 KiB  
Article
Genome Characterization of Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae Strains, Carrying Hybrid Resistance-Virulence IncHI1B/FIB Plasmids, Isolated from an Egyptian Pediatric ICU
by Heba A. Hammad, Radwa Abdelwahab, Douglas F. Browning and Sherine A. Aly
Microorganisms 2025, 13(5), 1058; https://doi.org/10.3390/microorganisms13051058 - 1 May 2025
Viewed by 175
Abstract
Despite the increased reporting of Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) in Egypt, there is a paucity of information regarding the molecular characteristics of such strains. Herein, we present the genome sequence of two CR-hvKp strains, K22 and K45, which were isolated from VAP [...] Read more.
Despite the increased reporting of Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) in Egypt, there is a paucity of information regarding the molecular characteristics of such strains. Herein, we present the genome sequence of two CR-hvKp strains, K22 and K45, which were isolated from VAP (ventilator-associated-pneumonia) patients admitted to pediatric ICU at Assiut University Children’s Hospital, Egypt. K22 and K45 isolates were subjected to antimicrobial susceptibility testing and whole-genome sequencing. Genomic analysis was performed to characterize each strain, determining their plasmids, antimicrobial resistance (AMR) genes, and virulence determinants. K22 possessed an extensive drug resistance phenotype (XDR), whilst K45 exhibited a multidrug resistance phenotype (MDR), with genome sequencing revealing the presence of a diverse array of AMR genes. Both strains were resistant to the carbapenem antibiotic imipenem, carrying the OXA-48 carbapenemase, with K22 additionally possessing an NDM-1 carbapenemase. Each strain was considered high-risk, with K22 and K45 respectively belonging to sequence types ST383 and ST14 and possessing virulence genes implicated in hypervirulence (e.g., iucABCD-iutA and rmpA). Importantly, both strains carried multiple plasmid replicons, including an AMR/virulence IncHI1B/FIB hybrid plasmid and MDR IncL/M plasmids. This report highlights the critical role of plasmids in the evolution of virulent K. pneumoniae strains and suggests the circulation of an IncHI1B/FIB hybrid plasmid, simultaneously disseminating AMR and hypervirulence, amongst K. pneumoniae strains within Assiut University Children’s Hospital. Full article
(This article belongs to the Special Issue Virulence and Resistance of Klebsiella pneumoniae, 2nd Edition)
Show Figures

Figure 1

12 pages, 1421 KiB  
Article
The Association between Resistance and Virulence of Klebsiella pneumoniae in High-Risk Clonal Lineages ST86 and ST101
by Irina Pristas, Josip Ujevic, Kristian Bodulić, Natasa Andrijasevic, Branka Bedenic, Marina Payerl-Pal, Edita Susic, Karolina Dobrovic, Sien De Koster, Surbhi Malhotra-Kumar and Arjana Tambic Andrasevic
Microorganisms 2024, 12(10), 1997; https://doi.org/10.3390/microorganisms12101997 - 30 Sep 2024
Cited by 2 | Viewed by 1457
Abstract
Klebsiella pneumoniae is an opportunistic pathogen known for two main pathotypes: classical K. pneumoniae (cKp), often multidrug-resistant and common in hospitals, and hypervirulent K. pneumoniae (hvKp), associated with severe community-acquired infections. The recent emergence of strains combining hypervirulence and resistance is alarming. This [...] Read more.
Klebsiella pneumoniae is an opportunistic pathogen known for two main pathotypes: classical K. pneumoniae (cKp), often multidrug-resistant and common in hospitals, and hypervirulent K. pneumoniae (hvKp), associated with severe community-acquired infections. The recent emergence of strains combining hypervirulence and resistance is alarming. This study investigates the distribution of sequence types (STs), resistance, and virulence factors in K. pneumoniae strains causing bloodstream and urinary tract infections in Croatia. In 2022, 200 consecutive K. pneumoniae isolates were collected from blood and urine samples across several Croatian hospitals. Whole genome sequencing was performed on 194 isolates. Within the analyzed K. pneumoniae population, the distribution of sequence types was determined with multi-locus sequence typing (MLST) and capsule loci, resistance, and virulence determinants were assessed with the bioinformatics tool Kleborate. The analysis identified 77 different STs, with ST101 (24.6%) being the most prevalent, predominantly linked to the K17 capsular type (CT), invasive device usage, high antimicrobial resistance, and low virulence scores. The highest virulence scores were recorded in ST86 isolates, which were predominantly linked to the K2 CT and included some strains with medium resistance scores. String tests were positive in 19 strains, but only four of those harbored hypermucoviscous genetic determinants. The most prevalent ST101 clone in Croatia demonstrated a diverging association between resistance and virulence. An alarming co-existence of resistance and virulence was recorded in the ST86 strains. Full article
(This article belongs to the Special Issue Virulence and Resistance of Klebsiella pneumoniae, 2nd Edition)
Show Figures

Figure 1

15 pages, 1847 KiB  
Article
Clinical and Genomic Characterization of Carbapenem-Resistant Klebsiella pneumoniae with Concurrent Production of NDM and OXA-48-like Carbapenemases in Southern California, 2016–2022
by Stacey Cerón, Zackary Salem-Bango, Deisy A. Contreras, Elizabeth L. Ranson and Shangxin Yang
Microorganisms 2023, 11(7), 1717; https://doi.org/10.3390/microorganisms11071717 - 30 Jun 2023
Cited by 8 | Viewed by 2504
Abstract
The global emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a critical public healthcare concern due to treatment challenges and high mortality. In recent years, there has been an increase in cases of CRKP co-producing New Delhi metallo-β-lactamases (NDM) and oxacillinase 48 (OXA-48)-like [...] Read more.
The global emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a critical public healthcare concern due to treatment challenges and high mortality. In recent years, there has been an increase in cases of CRKP co-producing New Delhi metallo-β-lactamases (NDM) and oxacillinase 48 (OXA-48)-like carbapenemases in the US. The aim of this study was to correlate the clinical and genomic characteristics of CRKP co-producing NDM and OXA-48-like carbapenemases isolated from patients in Southern California since 2016. Whole-genome sequencing was performed on clinical isolates obtained from various sources, including blood, abdominal fluid, wounds, and urine. Genetic diversity was observed in these CRKP, including ST-14, ST-16, ST-167, ST-437, ST-2096, and ST-2497 lineages. Phylogenetic analysis revealed two closely related clusters (ST-14 and ST-2497), with single nucleotide polymorphism (SNP) differences ranging from 0 to 36, suggesting a possible local spread of these CRKP. Significant antimicrobial resistance (AMR) genes were identified in these CRKP, including blaNDM-1, blaNDM-5, blaOXA-232, blaOXA-181, blaCTX-M-15, armA, tet(A), and tet(D). Moreover, pColKP3-type and Inc-type plasmids known to harbor AMR genes were also detected in these isolates. Most of the patients infected with this rare type of CRKP died, although their severe comorbidities also played important roles in their demise. Our study highlighted the extremely limited treatment options and poor clinical outcomes associated with these dual-carbapenemase-producing CRKP. Real-time genomic surveillance of these unusual and deadly CRKP can provide critical information for infection prevention and treatment guidance. Full article
(This article belongs to the Special Issue Virulence and Resistance of Klebsiella pneumoniae, 2nd Edition)
Show Figures

Figure 1

19 pages, 2723 KiB  
Article
Geno- and Phenotypic Characteristics of a Klebsiella pneumoniae ST20 Isolate with Unusual Colony Morphology
by Katharina Sydow, Elias Eger, Michael Schwabe, Stefan E. Heiden, Jürgen A. Bohnert, Sören Franzenburg, Christoph Jurischka, Peter Schierack and Katharina Schaufler
Microorganisms 2022, 10(10), 2063; https://doi.org/10.3390/microorganisms10102063 - 19 Oct 2022
Cited by 6 | Viewed by 5067
Abstract
Klebsiella pneumoniae is a common member of the intestinal flora of vertebrates. In addition to opportunistic representatives, hypervirulent (hvKp) and antibiotic-resistant K. pneumoniae (ABR-Kp) occur. While ABR-Kp isolates often cause difficult-to-treat diseases due to limited therapeutic options, hvKp is a pathotype that can [...] Read more.
Klebsiella pneumoniae is a common member of the intestinal flora of vertebrates. In addition to opportunistic representatives, hypervirulent (hvKp) and antibiotic-resistant K. pneumoniae (ABR-Kp) occur. While ABR-Kp isolates often cause difficult-to-treat diseases due to limited therapeutic options, hvKp is a pathotype that can infect healthy individuals often leading to recurrent infection. Here, we investigated the clinical K. pneumoniae isolate PBIO3459 obtained from a blood sample, which showed an unusual colony morphology. By combining whole-genome and RNA sequencing with multiple in vitro and in vivo virulence-associated assays, we aimed to define the respective Klebsiella subtype and explore the unusual phenotypic appearance. We demonstrate that PBIO3459 belongs to sequence type (ST)20 and carries no acquired resistance genes, consistent with phenotypic susceptibility tests. In addition, the isolate showed low-level virulence, both at genetic and phenotypic levels. We thus suggest that PBIO3459 is an opportunistic (commensal) K. pneumoniae isolate. Genomic comparison of PBIO3459 with closely related ABR-Kp ST20 isolates revealed that they differed only in resistance genes. Finally, the unusual colony morphology was mainly associated with carbohydrate and amino acid transport and metabolism. In conclusion, our study reveals the characteristics of a Klebsiella sepsis isolate and suggests that opportunistic representatives likely acquire and accumulate antibiotic resistances that subsequently enable their emergence as ABR-Kp pathogens. Full article
(This article belongs to the Special Issue Virulence and Resistance of Klebsiella pneumoniae, 2nd Edition)
Show Figures

Figure 1

19 pages, 907 KiB  
Article
Hypervirulence and Multiresistance to Antibiotics in Klebsiella pneumoniae Strains Isolated from Patients with Hospital- and Community-Acquired Infections in a Mexican Medical Center
by Areli Bautista-Cerón, Eric Monroy-Pérez, Luis Rey García-Cortés, Ernesto Arturo Rojas-Jiménez, Felipe Vaca-Paniagua and Gloria Luz Paniagua-Contreras
Microorganisms 2022, 10(10), 2043; https://doi.org/10.3390/microorganisms10102043 - 16 Oct 2022
Cited by 8 | Viewed by 2329
Abstract
Klebsiella pneumoniae is a pathogenic bacterium associated with different infectious diseases. This study aimed to establish the different association profiles of virulence genes related to the hypermucoviscous phenotype (HM), capsular serotypes, biofilm formation, and multidrug resistance in K. pneumoniae strains from patients with [...] Read more.
Klebsiella pneumoniae is a pathogenic bacterium associated with different infectious diseases. This study aimed to establish the different association profiles of virulence genes related to the hypermucoviscous phenotype (HM), capsular serotypes, biofilm formation, and multidrug resistance in K. pneumoniae strains from patients with hospital- and community-acquired infections. K. pneumoniae virulence genes and capsular serotypes were identified by PCR, antibiotic susceptibility by the Kirby–Bauer method, HM by the string test, and biofilm formation by measurement in polystyrene microtiter plates. Of a total of 150 strains from patients with hospital- (n = 25) and community-acquired infections (n = 125), 53.3% (80/150) were HM-positive and 46.7% (70/150) were HM-negative. HM-positive (68/80) and HM-negative (67/70) strains were biofilm-forming. Moreover, 58.7% (47/80) HM-positive and 57.1% (40/70) HM-negative strains were multidrug-resistant. Among HM-positive, HM-negative, and serotypes K1 (25/150), K2 (48/150), and non-K1/K2 strains, (77/150) the frequently detected adhesion genes were fimH, mrkD, ycfM, and kpn; entB, irp2, irp1, and ybtS, for iron acquisition; and rmpA for protectins. The gene association pattern fimH/kpn/mrkD/ycfM/entB/irp1/irp2/ybtS/fyuA (18/150) was frequent among the strains. K. pneumoniae strains from patients with hospital- and community-acquired infections demonstrated a wide diversity of virulence gene profiles related to phenotype (hypermucoviscosity, multidrug resistance, and biofilm formation) and serotypes. Full article
(This article belongs to the Special Issue Virulence and Resistance of Klebsiella pneumoniae, 2nd Edition)
Show Figures

Figure 1

Review

Jump to: Research

13 pages, 448 KiB  
Review
A Decade-Long Review of the Virulence, Resistance, and Epidemiological Risks of Klebsiella pneumoniae in ICUs
by Tao-An Chen, Ya-Ting Chuang and Chieh-Hui Lin
Microorganisms 2024, 12(12), 2548; https://doi.org/10.3390/microorganisms12122548 - 11 Dec 2024
Cited by 2 | Viewed by 2087
Abstract
Klebsiella pneumoniae, a major opportunistic pathogen, causes severe infections in both community and healthcare settings, especially in intensive care units (ICUs), where multidrug-resistant (MDR) strains, such as carbapenem-resistant K. pneumoniae (CRKP), pose significant treatment challenges. The rise in hypervirulent K. pneumoniae (hvKP) [...] Read more.
Klebsiella pneumoniae, a major opportunistic pathogen, causes severe infections in both community and healthcare settings, especially in intensive care units (ICUs), where multidrug-resistant (MDR) strains, such as carbapenem-resistant K. pneumoniae (CRKP), pose significant treatment challenges. The rise in hypervirulent K. pneumoniae (hvKP) with enhanced virulence factors complicates management further. The ST11 clone, prevalent in China, exhibits both resistance and virulence traits, contributing to hospital outbreaks. ICU patients, particularly those with comorbidities or prior antibiotic exposure, are at higher risk. Treatment is complicated by limited antibiotic options and the increasing prevalence of polymicrobial infections, which involve resistant pathogens like Pseudomonas aeruginosa and Acinetobacter baumannii. Combination therapies offer some promise, but mortality rates remain high, and resistance to last-resort antibiotics is growing. Infection control measures and personalized treatment plans are critical, alongside the urgent need for vaccine development to combat the rising threat of K. pneumoniae, particularly in vulnerable populations. Effective management requires improved diagnostic tools, antimicrobial stewardship, and innovative treatment strategies to reduce the burden of this pathogen, especially in resource-limited settings. This review aims to provide a comprehensive analysis of the virulence, resistance, and epidemiological risks of K. pneumoniae in ICUs over the past decade, highlighting the ongoing challenges and the need for continued efforts to combat this growing threat. Full article
(This article belongs to the Special Issue Virulence and Resistance of Klebsiella pneumoniae, 2nd Edition)
Show Figures

Figure 1

Back to TopTop