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Klebsiella pneumoniae and pyogenic liver abscess: Emerging clinical threats, virulence mechanisms and therapeutic strategies (Review)

  • Authors:
    • Gulam Mustafa Hasan
    • Taj Mohammad
    • Sobia Zaidi
    • Anas Shamsi
    • Sukhwinder Singh Sohal
    • Md. Imtaiyaz Hassan
  • View Affiliations / Copyright

    Affiliations: Department of Basic Medical Science, College of Medicine, Prince Sattam Bin Abdulaziz University, Al‑Kharj 11942, Saudi Arabia, Centre for Interdisciplinary Research in Basic Sciences, Jamia Millia Islamia, New Delhi 110025, India, Department of Biomedical Sciences, Heritage College of Osteopathic Medicine, Ohio University, Athens, OH 45701, USA, Centre of Medical and Bio‑Allied Health Sciences Research, Ajman University, Ajman P.O. Box 346, United Arab Emirates, Department of Laboratory Medicine, School of Health Sciences, College of Health and Medicine, University of Tasmania, Launceston, TAS 7250, Australia
    Copyright: © Hasan et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 90
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    Published online on: January 13, 2026
       https://doi.org/10.3892/mmr.2026.13800
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Abstract

Klebsiella pneumoniae has emerged as a leading cause of pyogenic liver abscess (PLA), driven by hypervirulent and multidrug‑resistant (MDR) strains that pose major diagnostic and therapeutic challenges. This organism exhibits extensive capsular diversity (K1‑K80), with serotypes K1, K2, K5, K20, K54 and K57 being the most associated with invasive infections and severe clinical outcomes. Increasing convergence between hypervirulence and MDR determinants threatens effective management worldwide. Pharmacological and safety limitations of current antibiotics, including nephrotoxicity of colistin, hepatotoxicity of tigecycline and poor drug penetration into abscess cavities, further complicate treatment and encourage exploration of non‑traditional strategies such as anti‑virulence or immunomodulatory approaches. Recent advancements in rapid diagnostic tools such as metagenomic sequencing, MALDI‑TOF and point‑of‑care PCR assays offer promising prospects for early detection and antimicrobial optimization. Pharmacokinetic challenges at the abscess site and the emergence of hybrid hvKp‑MDR strains emphasize the urgency of precision‑guided therapy and robust global surveillance. K. pneumoniae‑associated PLA thus represents an evolving global health threat and understanding serotype diversity, antibiotic limitations and diagnostic innovations is essential for developing more effective preventive and therapeutic strategies. The present review provides current insights into the epidemiology, pathogenesis and therapeutic challenges of K. pneumoniae‑associated PLA, while highlighting translational opportunities and research priorities to counter the escalating dual threat of hypervirulence and resistance.

View Figures

Figure 1

Mechanistic overview of Klebsiella
pneumoniae pathogenesis leading to pyogenic liver abscess
(PLA). The schematic shows gut colonization and translocation, key
virulence factors (capsule, siderophores, fimbriae and LPS),
bloodstream invasion, hepatic colonization, abscess formation and
metastatic dissemination. PLA, pyogenic liver abscess; LPS,
lipopolysaccharide.

Figure 2

Convergence of hypervirulence and
multidrug resistance in Klebsiella pneumoniae: an evolving
global threat. The schematic contrasts the historical separation of
classical (cKp) and hypervirulent (hvKp) lineages with recent
plasmid-mediated convergence events that produce
carbapenem-resistant hypervirulent strains. These hybrid strains
represent a critical global health threat due to invasive disease
and limited therapeutic options. LPS, lipopolysaccharide; pLVPK,
large virulence plasmid of Klebsiella pneumoniae; MDR,
multidrug resistance; ESBLs, extended-spectrum β-lactamases; KPC,
Klebsiella pneumoniae carbapenemase; NDM, New Delhi
metallo-β-lactamase; OXA-48, oxacillinase-48.

Figure 3

Emerging therapeutic approaches
against Klebsiella pneumoniae-induced PLA. The central
illustration shows hypervirulent, drug-resistant K.
pneumoniae with capsule, pili and siderophores. Surrounding
panels highlight six strategies: Novel antibiotics, anti-virulence
agents, vaccines, monoclonal antibodies, bacteriophage therapy and
nanotechnology/immune modulation. Colour codes indicate
antibiotic-based (blue), immune/vaccine-based (green) and
innovative approaches (orange). PLA, pyogenic liver abscess; MDR,
multidrug resistance; hvKp, hypervirulent Klebsiella
pneumoniae.
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Copy and paste a formatted citation
Spandidos Publications style
Hasan GM, Mohammad T, Zaidi S, Shamsi A, Sohal SS and Hassan MI: <p><em>Klebsiella pneumoniae</em> and pyogenic liver abscess: Emerging clinical threats, virulence mechanisms and therapeutic strategies (Review)</p>. Mol Med Rep 33: 90, 2026.
APA
Hasan, G.M., Mohammad, T., Zaidi, S., Shamsi, A., Sohal, S.S., & Hassan, M.I. (2026). <p><em>Klebsiella pneumoniae</em> and pyogenic liver abscess: Emerging clinical threats, virulence mechanisms and therapeutic strategies (Review)</p>. Molecular Medicine Reports, 33, 90. https://doi.org/10.3892/mmr.2026.13800
MLA
Hasan, G. M., Mohammad, T., Zaidi, S., Shamsi, A., Sohal, S. S., Hassan, M. I."<p><em>Klebsiella pneumoniae</em> and pyogenic liver abscess: Emerging clinical threats, virulence mechanisms and therapeutic strategies (Review)</p>". Molecular Medicine Reports 33.3 (2026): 90.
Chicago
Hasan, G. M., Mohammad, T., Zaidi, S., Shamsi, A., Sohal, S. S., Hassan, M. I."<p><em>Klebsiella pneumoniae</em> and pyogenic liver abscess: Emerging clinical threats, virulence mechanisms and therapeutic strategies (Review)</p>". Molecular Medicine Reports 33, no. 3 (2026): 90. https://doi.org/10.3892/mmr.2026.13800
Copy and paste a formatted citation
x
Spandidos Publications style
Hasan GM, Mohammad T, Zaidi S, Shamsi A, Sohal SS and Hassan MI: <p><em>Klebsiella pneumoniae</em> and pyogenic liver abscess: Emerging clinical threats, virulence mechanisms and therapeutic strategies (Review)</p>. Mol Med Rep 33: 90, 2026.
APA
Hasan, G.M., Mohammad, T., Zaidi, S., Shamsi, A., Sohal, S.S., & Hassan, M.I. (2026). <p><em>Klebsiella pneumoniae</em> and pyogenic liver abscess: Emerging clinical threats, virulence mechanisms and therapeutic strategies (Review)</p>. Molecular Medicine Reports, 33, 90. https://doi.org/10.3892/mmr.2026.13800
MLA
Hasan, G. M., Mohammad, T., Zaidi, S., Shamsi, A., Sohal, S. S., Hassan, M. I."<p><em>Klebsiella pneumoniae</em> and pyogenic liver abscess: Emerging clinical threats, virulence mechanisms and therapeutic strategies (Review)</p>". Molecular Medicine Reports 33.3 (2026): 90.
Chicago
Hasan, G. M., Mohammad, T., Zaidi, S., Shamsi, A., Sohal, S. S., Hassan, M. I."<p><em>Klebsiella pneumoniae</em> and pyogenic liver abscess: Emerging clinical threats, virulence mechanisms and therapeutic strategies (Review)</p>". Molecular Medicine Reports 33, no. 3 (2026): 90. https://doi.org/10.3892/mmr.2026.13800
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