Antibiotic-resistant Klebsiella pneumoniae: phenotypic mechanisms and epidemiological patterns: Review Article

Almendra Julieta Chávez Barrón; Aurora Martínez-Romero; Rebeca Pérez-Morales; Graciela Castro-Escarpulli; José de Jesús Alba-Romero

doi:10.58372/2835-6276.1383

Authors

Almendra Julieta Chávez Barrón UJED
Aurora Martínez-Romero UJED https://orcid.org/0000-0002-9894-504X
Rebeca Pérez-Morales UJED https://orcid.org/0000-0003-1102-4553
Graciela Castro-Escarpulli Instituto Politécnico Nacional https://orcid.org/0000-0002-7496-8247
José de Jesús Alba-Romero Laboratorio Clínico Asesores Especializados de La Laguna https://orcid.org/0000-0003-2324-3251

DOI:

https://doi.org/10.58372/2835-6276.1383

Keywords:

Klebsiella pneumoniae, antimicrobial resistance, β-lactamases, carbapenemases, virulence factors, multidrug resistance

Abstract

Klebsiella pneumoniae has become a pathogen of significant clinical relevance due to the increasing prevalence of antimicrobial resistance and its remarkable ability to adapt to diverse environments. This Gram-negative bacillus is associated with both hospital-acquired and community-acquired infections and contributes to the emergence of multidrug-resistant strains. This study presents a literature review conducted through a search of the PubMed database, in which articles published during the last six years related to resistance mechanisms, virulence factors, and the epidemiology of K. pneumoniae were selected. Available evidence indicates a global increase in multidrug-resistant strains, particularly those producing β-lactamases and carbapenemases. In addition, virulence factors such as the capsule, lipopolysaccharide, fimbriae, siderophores, and biofilm formation contribute to bacterial colonization. These mechanisms limit available therapeutic options and highlight the importance of strengthening epidemiological surveillance and promoting the rational use of antibiotics.

References

Dong N, Yang X, Chan EWC, Zhang R, Chen S. Klebsiella species: Taxonomy, hypervirulence and multidrug resistance. eBioMedicine. 2022;79:1-11.

Qureshi S. Klebsiella Infections. Medscape. 2024:1-20.

Tomulescu C, Moscovici M, Lupescu I, Stoica RM, Vamanu A. A Review: Klebsiella pneumoniae, Klebsiella oxytoca and Biotechnology. Romanian Biotechnological Letters. 2021;26(3):2567-86.

Salam MA, Al-Amin MY, Salam MT, Pawar JS, Akhter N, Rabaan AA, et al. Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. healthcare. 2023;11(1946):1-20.

Toledano-Tableros JE, Gayosso-Vázquez C, Jarillo-Quijada MD, Fernández-Vázquez JL, Morfin-Otero R, Rodríguez-Noriega E, et al. Dissemination of blaNDM-1 Gene Among Several Klebsiella pneumoniae Sequence Types in Mexico Associated With Horizontal Transfer Mediated by IncF-Like Plasmids. Frontiers in Microbiology. 2021;12:1-9.

Ochońska D, Brzychczy-Włoch M. Klebsiella pneumoniae – Taxonomy, occurrence, identification, virulence factors and pathogenicity. Advancements of Microbiology. 2024;63(3):157-75.

Pinpimai K, Banlunara W, Roe WD, Dittmer K, Biggs PJ, Tantiletracharoen R, et al. Genetic characterization of hypervirulent Klebsiella pneumoniae responsible for acute death in captive marmosets. Frontiers in Veterinary Science. 2022:1-9.

Hafiz TA, Alanazi S, Alghamdi SS, Mubarak MA, Aljarb W, Madkhali N, et al. Klebsiella pneumoniae bacteraemia epidemiology: resistance profiles and clinical outcome of King Fahad Medical City isolates, Riyadh, Saudi Arabia. BMC Infectious Diseases. 2023;23:1-9.

Jiang M, Qiu X, Shui S, Zhao R, Lu W, Lin C, et al. Differences in molecular characteristics and expression of virulence genes in carbapenem-resistant and sensitive Klebsiella pneumoniae isolates in Ningbo, China. Frontiers in Microbiology. 2024;15:1-11.

Vazquez NM, Moreno S, Galván EM. Exposure of multidrug-resistant Klebsiella pneumoniae biofilms to 1,8-cineole leads to bacterial cell death and biomass disruption. Biofilm. 2022;4:1-7.

Souza-Guerra ME, Destro G, Vieira B, Lima AS, Caldas-Ferraz LF, Hakansson AP, et al. Klebsiella pneumoniae biofilms and their role in disease pathogenesis. Frontiers in Cellular and Infection Microbiology. 2022;12:1-13.

OMS. Global antibiotic resistance surveillance report 2025. In: Organization WH, editor. 2025. p. 1-138.

Lin X-C, Li C-L, Zhang S-Y, Yang X-F, Jiang M. The global and regional prevalence of hospital-acquired carbapenem-resistant Klebsiella pneumoniae infection: A systematic review and meta-analysis. Open Forum Infectious Diseases. 2023;11:1-15.

Bautista-Cerón A, Monroy-Pérez E, García-Cortés LR, Rojas-Jiménez EA, Vaca-Paniagua F, Paniagua-Contreras GL. Hypervirulence and multiresistance to antibiotics in Klebsiella pneumoniae strains isolated from patients with hospital- and community-acquired infections in a Mexican medical center. Microorganisms. 2022;10(10):1-19.

Peñaloza-Juárez JU, Rivera-Leaños RB, Cruz-García E, Morales-Landeros LF. Prevalencia y sensibilidad antimicrobiana de Klebsiella pneumoniae en un Hospital de Cardiología. Revista Médica del Instituto Mexicano del Seguro Social. 2023:6S.

UNAM. Resistencia antimicrobiana en México 2017 a 2023. Universidad Nacional Autónoma de México Plan Universitario de Control de la Resistencia Antimicrobiana (PUCRA); 2024.

Asokan S, Jacob T, Jacob J, AlSosowaa AA, Cherian T, Peijnenburg WJGM, et al. Klebsiella pneumoniae: A growing threat in the era of antimicrobial resistance. The Microbe. 2025;7:1-15.

Mina-Ortiz JB, Quimis-Cañarte JE, Pinto-Nogales ES, Vitonera-Rogel RA, Lino-Villacreses WA. Resistencia antibiótica en bacilos Gram negativos: Betalactamasas AmpC. Dominio de las Ciencias. 2021;7(3):314-40.

Das P, Mahapatra D, Sen-Mazumder S. A Guide Towards the Phenotypic Detection of Extended-spectrum β-lactamases Production in Enterobacteriaceae: Alone or in Presence of Other Interfering Enzymes. Journal of Pure and Applied Microbiology. 2023;17(3):1410-21.

Lirola-Andreu L, Ávila-Jiménez ÁF, Fernández-Mariscal MA, Reinoso-Espín Á, Martínez-Martínez S. La resistencia bacteriana. Generalidades, carbapenemasas y actualidad: una revisión narrativa. Archivos de Medicina Universitaria. 2022:65-75.

Luo C, Chen Y, Hu X, Chen S, Lin Y, Liu X, et al. Genetic and Functional Analysis of the pks Gene in Clinical Klebsiella pneumoniae Isolates. Microbiol Spectr. 2023;11(4):e0017423.

Parrott AM, Shi J, Aaron J, Green DA, Whittier S, Wu F. Detection of multiple hypervirulent Klebsiella pneumoniae strains in a New York City hospital through screening of virulence genes. Clin Microbiol Infect. 2021;27(4):583-9.

Abbas R, Chakkour M, Zein-El-Dine H, Florunsho-Obaseki E, Obeid ST, Jezzini A, et al. General Overview of Klebsiella pneumoniae: Epidemiology and the Role of Siderophores in Its Pathogenicity. Biology. 2024;13(78):1-19.

Hetta HF, Alanazi FE, Ali MAS, Alatawi AD, Aljohani HM, Ahmed R, et al. Hypervirulent Klebsiella pneumoniae: Insights into Virulence, Antibiotic Resistance, and Fight Strategies Against a Superbug. Pharmaceuticals (Basel). 2025;18(5).

Riwu KHP, Effendi MH, Rantam FA, Khairullah AR, Widodo A. A review: Virulence factors of Klebsiella pneumoniae as emerging infection on the food chain. Veterinary World. 2022;15(9):2172-9.

Karampatakis T, Tsergouli K, Behzadi P. Carbapenem-Resistant Klebsiella pneumoniae: Virulence Factors, Molecular Epidemiology and Latest Updates in Treatment Options. Antibiotics (Basel). 2023;12(2).

Nguyen TNT, Howells G, Short FL. How Klebsiella pneumoniae controls its virulence. PLoS Pathog. 2025;21(9):e1013499.

Singh RP, Kapoor A, Sinha A, Ma Y, Shankar M. Virulence factors of Klebsiella pneumoniae: Insights into canonical and emerging mechanisms driving pathogenicity and drug resistance. The Microbe. 2025:1-30.

Moustafa HAE, Hussein AMI, Zaki LG, El-Shennawy GA. Klebsiella pneumoniae: Morphological characteristics, growth, cultural characters, antigenic structures, virulence factors and vaccines strategies. International Journal of Chemical and Biochemical Sciences. 2023;24(10):884-93.

Abebe AA, Birhanu AG, Tessema TS. Antibiotic Resistance and Virulence Mechanisms in Klebsiella pneumoniae: Understanding for Better Interventions. Bacteria. 2026;5:1-9.

Jin SS, Wang WQ, Jiang YH, Yu YT, Wang RL. A Comprehensive Overview of Klebsiella Pneumoniae: Resistance Dynamics, Clinical Manifestations, and Therapeutic Options. Infect Drug Resist. 2025;18:1611-28.

Kumar A, Chakravorty S, Yang T, Russo TA, Newton SM, Klebba PE. Siderophore-mediated iron acquisition by Klebsiella pneumoniae. J Bacteriol. 2024;206(5):e0002424.

Lan P, Lu Y, Fu Y, Yu Y, Zhou J. Siderophores and beyond: A comprehensive review of iron acquisition in Klebsiella pneumoniae. Virulence. 2025;16(1):2550621.

Choby JE, Howard-Anderson J, Weiss DS. Hypervirulent Klebsiella pneumoniae – clinical and molecular perspectives. Journal of Internal Medicine. 2020;287(3):283-300.

Zhu J, Wang T, Chen L, Du H. Virulence Factors in Hypervirulent Klebsiella pneumoniae. Front Microbiol. 2021;12:642484.

Lenchenko E, Blumenkrants D, Sachivkina N, Shadrova N, Ibragimova A. Morphological and adhesive properties of Klebsiella pneumoniae biofilms. Vet World. 2020;13(1):197-200.

Li Y, Ni M. Regulation of biofilm formation in Klebsiella pneumoniae. Front Microbiol. 2023;14:1238482.

Shadkam S, Goli HR, Mirzaei B, Gholami M, Ahanjan M. Correlation between antimicrobial resistance and biofilm formation capability among Klebsiella pneumoniae strains isolated from hospitalized patients in Iran. Ann Clin Microbiol Antimicrob. 2021;20(1):13.

Wang G, Zhao G, Chao X, Xie L, Wang H. The Characteristic of Virulence, Biofilm and Antibiotic Resistance of Klebsiella pneumoniae. Int J Environ Res Public Health. 2020;17(17).

Pu D, Zhao J, Chang K, Zhuo X, Cao B. "Superbugs" with hypervirulence and carbapenem resistance in Klebsiella pneumoniae: the rise of such emerging nosocomial pathogens in China. Sci Bull (Beijing). 2023;68(21):2658-70.

Azam M, Gaind R, Yadav G, Sharma A, Upmanyu K, Jain M, et al. Colistin Resistance Among Multiple Sequence Types of Klebsiella pneumoniae Is Associated With Diverse Resistance Mechanisms: A Report From India. Front Microbiol. 2021;12:609840.

Bedair HM, Emara M, Ali SM, Samir TM, Khalil MAF. Phenotypic and genotypic screening of multidrug resistant Klebsiella pneumoniae isolated from ready to eat street food in Tanta, Egypt. BMC Microbiol. 2025;25(1):65.

Cheetham MJ, Huo Y, Stroyakovski M, Cheng L, Wan D, Dell A, et al. Specificity and diversity of Klebsiella pneumoniae phage-encoded capsule depolymerases. Essays Biochem. 2024;68(5):661-77.