# Co-evolution of resistance and virulence in Klebsiella pneumoniae liver abscess: PLA-specific mechanisms and therapeutic dilemmas

## TL;DR

This review explores how Klebsiella pneumoniae combines drug resistance and high virulence in liver abscesses, complicating diagnosis and treatment.

## Contribution

The paper consolidates current knowledge on PLA-specific mechanisms of CR-hvKP and proposes translational strategies for managing these infections.

## Key findings

- CR-hvKP combines carbapenem resistance with hypervirulence through plasmid fusion and horizontal gene transfer.
- Key virulence factors like K1/K2 capsule and aerobactin are critical for hepatic infection in PLA.
- Rapid diagnostics and anti-virulence strategies are emerging as potential solutions for CR-hvKP management.

## Abstract

The co-evolution of resistance and virulence in Klebsiella pneumoniae poses a significant challenge in the management of pyogenic liver abscesses (PLA), particularly with the advent of carbapenem-resistant hypervirulent K. pneumoniae (CR-hvKP). This review specifically addresses PLA to consolidate current knowledge on how key virulence factors—such as the K1/K2 capsule, hypermucoviscosity, and aerobactin—contribute to hepatic infection. It also examines the molecular mechanisms, including plasmid fusion and horizontal gene transfer, that are believed to facilitate the convergence of hypervirulence and carbapenem resistance. Additionally, the review discusses the unique clinical challenges presented by CR-hvKP in the context of PLA, including diagnostic delays, antimicrobial treatment failures, and complications in drainage. Emerging countermeasures, such as rapid molecular diagnostics and novel anti-virulence strategies, are also explored. By integrating contemporary molecular insights with the specific clinical challenges of PLA management, this review provides an updated translational perspective aimed at bridging the gap between pathogenesis and therapeutic strategies for CR-hvKP-associated infections.