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. 2025 Apr;29(4):370-393.
doi: 10.5005/jp-journals-10071-24957.

Prevalence, Risk Factors, and Clinical Outcomes of Hypervirulent Klebsiella pneumoniae Strains among Klebsiella pneumoniae Infections: A Systematic Review and Meta-analysis

Danavath Nagendra  1 , Souvik Chaudhuri  1 , Nitin Gupta  2 , Vishal Shanbhag  1 , Vandana K Eshwara  3 , Shwethapriya Rao  1 , Muralidhar Varma  2 , Thejesh Srinivas  1 , Pratibha Todur  4 , P S Priya  5 , Vinutha R Bhat  6
Affiliations

Prevalence, Risk Factors, and Clinical Outcomes of Hypervirulent Klebsiella pneumoniae Strains among Klebsiella pneumoniae Infections: A Systematic Review and Meta-analysis

Danavath Nagendra et al. Indian J Crit Care Med. 2025 Apr.

Abstract

Aim and background: Hypervirulent Klebsiella pneumoniae (HvKp) is a virulent strain associated with invasive infections. While initially community-acquired, hospital-acquired HvKp (HA-HvKp) and carbapenem-resistant HvKp (CR-HvKp) are increasingly reported. This meta-analysis evaluates the prevalence, risk factors, and clinical outcomes associated with HvKp, including CR-HvKp and HA-HvKp, among Kp infections.

Methodology: A systematic search of PubMed, Scopus, Embase, and Cochrane Library was conducted until December 2024. Observational studies comparing HvKp vs classical Kp (cKp), CR-HvKp vs carbapenem-sensitive HvKp (CS-HvKp), and HA-HvKp vs community-acquired HvKp (CA-HvKp) were included. Quality was assessed using the Joanna Briggs Critical Appraisal Tool, and pooled prevalence and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated.

Results: Fifty studies with 6,663 participants were included. The HvKp prevalence was 33.0%, with most studies from Asia, predominantly China. Temporal analysis revealed an increase in HvKp prevalence (27.7% in 2006-2018 to 38.5% in 2019-2024). The CR-HvKp prevalence rose from 9.5% to 16.5% (2016-2024). The HA-HvKp prevalence increased from 25.9 to 47.1%. Key risk factors included diabetes mellitus (OR = 1.56), CA-Kp (OR = 2.59), and hypermucoviscous (HM)-phenotype (OR = 29.79). Complications included liver abscess (OR = 6.35), metastatic spread (OR = 4.74), meningitis (OR = 11.14), and septic shock (OR = 1.30). Mortality was higher in HvKp infections but not statistically significant (p = 0.219). HA-HvKp and immunosuppression were significant CR-HvKp risk factors, with CR-HvKp showing higher mortality.

Conclusions: Diabetes mellitus, CA-Kp infections, and HM-phenotype are significant risk factors for HvKp. The rising prevalence of CR-HvKp and HA-HvKp highlights the need for early detection, infection control, and targeted treatment strategies.

How to cite this article: Nagendra D, Chaudhuri S, Gupta N, Shanbhag V, Eshwara VK, Rao S, et al. Prevalence, Risk Factors, and Clinical Outcomes of Hypervirulent Klebsiella pneumoniae Strains among Klebsiella pneumoniae Infections: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2025;29(4):370-393.

Keywords: Carbapenem-resistant; Clinical outcomes; Hospital-acquired infections; Hypervirulent Klebsiella pneumoniae; Prevalence; Risk factors.

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Conflict of interest statement

Source of support: Nil Conflict of interest: NoneConflict of interest: None

Figures

Fig. 1
Fig. 1
PRISMA flowchart showing screening and inclusion of studies with hypervirulent K. pneumoniae Source: Page MJ, McKenzie JE, Bossuyt PM et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ 2021;372:n71. DOI: 10.1136/bmj.n.71
Fig. 2
Fig. 2
Prevalence of HvKp and changing of prevalence over two time periods (2006–2018 and 2019–2024)
Fig. 3
Fig. 3
Funnel plot
Fig. 4
Fig. 4
Definition of HvKp in this SRMA, types of HvKp, risk factors, and outcomes
Fig. 5
Fig. 5
The prevalence of HvKp according to regions and the various clinical outcomes are depicted HvKp, hypervirulent Klebsiella pneumoniae; Kp, Klebsiella pneumoniae
See this image and copyright information in PMC

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