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Clinical Outcomes in Hypervirulent Carbapenem-Resistant Klebsiella pneumoniae Infection: A Cohort Study

Ya Hu1,2, Qingqing Fang1,2,3, Linwan Zhang1,4

  • 1Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.

The Journal of Infectious Diseases
|March 13, 2026
PubMed
Abstract

Insights

Hypervirulent carbapenem-resistant Klebsiella pneumoniae (hvCRKP) did not worsen patient outcomes compared to classic CRKP. This study suggests the concept of hvCRKP may be overemphasized in its current form.

Area of Science:

  • Infectious Diseases
  • Microbiology
  • Clinical Medicine

Background:

  • Klebsiella pneumoniae is a significant pathogen, with carbapenem resistance and hypervirulence being common evolutionary traits.
  • The emergence of hypervirulent carbapenem-resistant K. pneumoniae (hvCRKP) raises concerns, but its impact on patient outcomes is unclear.

Purpose of the Study:

  • To investigate whether hypervirulence exacerbates patient outcomes in carbapenem-resistant K. pneumoniae (CRKP) infections.
  • To compare outcomes between patients infected with hvCRKP and non-hypervirulent classic CRKP (cCRKP).

Main Methods:

  • An observational cohort study using 3-year data (2019-2022) from a Chinese university hospital.
  • Genome sequencing of CRKP strains was performed.
  • Propensity score matching was used to compare adult patients infected with hvCRKP versus cCRKP, analyzing 30-day mortality and other clinical outcomes.

Main Results:

  • No significant differences were observed in 30-day all-cause mortality (30.9% vs 33.7%), infection-attributed mortality (24.4% vs 26.2%), or no response/progress rates (19.8% vs 20.4%) between hvCRKP and cCRKP groups.
  • Post-infection hospital stay (median 13 vs 15 days) and survival (median 18.5 vs 24.5 days) were also similar between the groups.
  • These findings remained consistent after propensity score matching and subgroup analyses.

Conclusions:

  • The clinical significance of hypervirulence in Klebsiella pneumoniae, particularly in carbapenem-resistant strains, requires further definition.
  • The current concept of hypervirulent carbapenem-resistant K. pneumoniae (hvCRKP) may warrant re-evaluation and should not be overemphasized.
Keywords:
Klebsiella pneumoniaecarbapenem resistancehvCRKPhypervirulentoutcome

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