A Global Perspective on the Convergence of Hypervirulence and Carbapenem-Resistance in Klebsiella pneumoniae.

Hypervirulence and carbapenem resistance have emerged as two distinct evolutionary directions for K. pneumoniae that pose great threat in clinical settings. Multiple virulence factors contribute to the hypervirulence and the mechanisms of carbapenem resistance is complicated. However, more and more K. pneumoniae strains were identified integrating both the two phenotypes and thus resulting in devastating clinical outcomes in recent years. Hypervirulent and carbapenem-resistant K. pneumoniae (CR-hvKP) emerged in the early 2010s and onwards become increasingly prevalent. CR-hvKP is primarily prevalent in Asia, especially in China, and is reported all over the world. The mechanisms for the emergence of CR-hvKP can be summarized to three patterns, 1). CRKP acquiring hypervirulence phenotype; 2). hvKP acquiring cabarpenem resistance phenotype and 3). K. pneumoniae acquiring CR- and hv- hybrid plasmid. With the global dissemination, continued surveillance of the emergence of CR-hvKP should be more highly prioritized.