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Published on: November 28, 2025
Pulmonary and extra-pulmonary infections caused by classical and hypervirulent Klebsiella pneumoniae: a prospective
Fatma Alshehri1, Rasha A Mosbah2,3, Sozan M Abdelkhalig4,5
1Department of Biology, College of Sciences, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia.
Aim:
Klebsiella pneumoniae (K. pneumoniae) is an opportunistic pathogen causing infections ranging from pulmonary disease to severe systemic illness. This study aimed to examine the relationships between infection site, pathotype, virulence, resistance, and clinical presentations to manage classical (cKp) and hypervirulent (hvKp) strains.
Methods And Results:
600 clinical specimens were screened for K. pneumoniae. Virulence and resistance fitness were analyzed phenotypically and genotypically. Clinical correlations were assessed to link pathotype, resistance, virulence, infection site, age, and presentation. K. pneumoniae was detected in 17.2% specimens (103/600), with pulmonary samples showing 43% positivity versus 12% in extra-pulmonary ones. hvKp accounted for 55.3% and cKp for 44.7% of isolates; hvKp predominated in extra-pulmonary infections (83.3%) and cKp in pulmonary cases (83.7%). K1 (33.1%) and K2 (21.4%) were confined to hvKp, while pulmonary isolates were mainly K3, K5, and K20. Pulmonary infections mainly affected adults (81.4%) and showed respiratory signs; extra-pulmonary cases occurred mostly in pediatric (46.7%) and elderly (41.7%) patients with systemic symptoms such as fever and hypotension. Clustering distinguished pulmonary/cKp (MDR-rich) from extra-pulmonary/hvKp (virulence-rich) isolates, with some overlap indicating hybrid strains. Correlations linked pulmonary infections with cKp and MDR (r = 0.67), and extra-pulmonary infections with hvKp and systemic disease (r = 0.67).
Conclusion:
The high MDR burden of cKp underscores the need for stronger antimicrobial stewardship and new therapies, while the invasive nature of hvKp highlights the importance of early recognition and rapid intervention to prevent systemic complications. Early distinction of cKp from hvKp can significantly influence treatment decisions and reduce morbidity and mortality associated with K. pneumoniae infections.
Insights
This study differentiated classical (cKp) and hypervirulent (hvKp) Klebsiella pneumoniae strains, finding cKp linked to pulmonary infections and MDR, while hvKp is associated with extra-pulmonary infections and systemic disease. Early distinction is crucial for effective K. pneumoniae management.
Area of Science:
- Microbiology
- Infectious Diseases
- Clinical Medicine
Background:
- Klebsiella pneumoniae is an opportunistic pathogen causing diverse infections.
- Classical K. pneumoniae (cKp) and hypervirulent K. pneumoniae (hvKp) strains exhibit distinct characteristics.
- Understanding the interplay between infection site, pathotype, virulence, and resistance is vital for patient management.
Purpose of the Study:
- To investigate the relationships between infection site, pathotype, virulence, resistance, and clinical presentations of K. pneumoniae.
- To differentiate between classical (cKp) and hypervirulent (hvKp) K. pneumoniae strains.
- To inform clinical management strategies for K. pneumoniae infections.
Main Methods:
- Screening of 600 clinical specimens for K. pneumoniae.
- Phenotypic and genotypic analysis of virulence and resistance.
- Clinical correlation assessment linking pathotype, resistance, virulence, infection site, age, and presentation.
Main Results:
- K. pneumoniae detected in 17.2% of specimens; pulmonary samples had higher positivity (43%) than extra-pulmonary (12%).
- hvKp (55.3%) predominated in extra-pulmonary infections, while cKp (44.7%) was more common in pulmonary infections.
- Pulmonary infections (mainly adults, respiratory signs) correlated with cKp and MDR; extra-pulmonary infections (pediatric/elderly, systemic symptoms) correlated with hvKp.
Conclusions:
- cKp strains present a high multidrug-resistance (MDR) burden, necessitating enhanced antimicrobial stewardship and novel therapies.
- hvKp strains exhibit invasive potential, emphasizing the need for early recognition and prompt intervention to prevent severe outcomes.
- Distinguishing between cKp and hvKp is critical for guiding treatment decisions and improving patient outcomes in K. pneumoniae infections.
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