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Klebsiella pneumoniae is a common and well-established pathogen associated with hospitaland healthcare-acquired infections worldwide. A hypervirulent K. pneumoniae (hvKP) variant associated with primary pyogenic liver abscesses was initially described in Taiwan (Liu et al., 1986) and was subsequently reported in North America (Fierer et al., 2011; Lederman & Crum, 2005a; McCabe et al., 2010; Nadasy et al., 2007; Pastagia & Arumugam, 2008; Peirano et al., 2013), Australia (Chang et al., 2013) and Europe (Keynan et al., 2007). magA (mucoviscosity-associated gene A), which is on the same operon responsible for capsular serotype K1, was the first gene described to lead to a hypermucoviscous phenotype and thought to be related to the ability of hvKP to form pyogenic liver abscesses (Fang et al., 2004; Chuang et al., 2006). Later, a second gene, rmpA (regulator of mucoid phenotype A), was reported to be associated with K. pneumoniae causing pyogenic tissue abscesses (Yu et al., 2006). More recently, whole-genome sequencing found rmpA and genes encoding iron acquisition systems to be conserved in hvKP isolates and that rmpA is found in isolates with K1 and nonK1 capsular serotypes (Struve et al., 2015).

Prevalence of hypervirulent Klebsiella pneumoniae-associated genes rmpA and magA in two tertiary hospitals in Houston, TX, USA