Call for prudent use of the term hypervirulence in carbapenem-resistant Klebsiella pneumoniae

In July, 2024, WHO issued a global alert regarding the increasing incidence of hypervirulent Klebsiella pneumoniae (hvKP) sequence type (ST) 23, which carry genes encoding carbapenemases that confer hvKP with resistance to the vast majority of clinically available β-lactams.1 The combination of hypervirulence and carbapenem resistance is a unique double threat to clinical management and public health. ST23 K pneumoniae is a well known hypervirulent lineage and can acquire carbapenemase genes. Alternatively, carbapenem-resistant K pneumoniae (CRKP) can acquire multiple virulence-encoding genes (eg, rmpA, rmpA2, iucA or iutA, iroB or iroN, and peg-344) associated with hvKP to become hypervirulent carbapenem-resistant K pneumoniae (hvCRKP), which is becoming more common and is increasingly being reported in the literature.