Carbapenem-resistant hypervirulent Klebsiella pneumoniae: molecular evolution, diagnostic markers, and therapeutic challenges

Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKp) is an emerging convergent pathotype in which antimicrobial resistance (AMR) and invasive virulence increasingly overlap. This Mini Review critically summarizes how CR-hvKp arises through acquisition of carbapenemase-encoding plasmids by hypervirulent backgrounds, acquisition of virulence plasmids by established carbapenem-resistant lineages, and formation of hybrid resistance-virulence elements. It also discusses why laboratory recognition remains challenging, since carbapenem resistance, hypermucoviscosity, capsule type, and individual virulence markers are each informative but insufficient alone. A tiered diagnostic approach that integrates susceptibility testing, carbapenemase classification, virulence-marker profiling, capsule and sequence typing, and genome sequencing is therefore more appropriate for high-risk isolates. Therapeutic management remains difficult because available agents must be selected according to carbapenemase class, infection site, source control, susceptibility profile, and risk of resistance emergence. Available evidence supports prioritizing earlier recognition, plasmid-aware surveillance, antimicrobial stewardship, and outcome-focused studies as priorities for improving management of this high-risk convergent pathotype.