Summary
Background
Hypervirulent Klebsiella pneumoniae (hvKp) infections confer notable morbidity and mortality. Differential diagnosis
to determine whether the infections are caused by either the hvKp or classical K. pneumoniae (cKp) strain is particularly important for undertaking optimal clinical care and
infection control efforts.
Aim
To identify and assess the potential predictors of hvKp infections.
Methods
PubMed, Web of Science, and Cochrane Library databases were searched for all relevant
publications from January 2000 to March 2022. The search terms included a combination
of the following terms: (i) Klebsiella pneumoniae or K. pneumoniae and (ii) hypervirulent or hypervirulence. A meta-analysis of factors for which risk
ratio was reported in three or more studies was conducted, and at least one statistically
significant association was identified.
Findings
In this systematic review of 11 observational studies, a total of 1392 patients with
K. pneumoniae infection and 596 (42.8%) with hvKp strains were evaluated. In the meta-analysis,
diabetes mellitus and liver abscess (pooled risk ratio: 2.61 (95% confidence interval:
1.79–3.80) and 9.04 (2.58–31.72), respectively; all P < 0.001) were predictors of hvKp infections.
Conclusion
For patients with a history of the abovementioned predictors, prudent management,
including the search for multiple sites of infection and/or metastatic spread and
the enforcement of an early and appropriate source control procedure, should be initiated
in consideration of the potential presence of hvKp. We believe that this research
highlights the urgent need for increasing clinical awareness of the management of
hvKp infections.
Keywords
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Article info
Publication history
Published online: February 20, 2023
Accepted:
February 8,
2023
Received:
November 17,
2022
Identification
Copyright
© 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
