Rifampicin as an antivirulence adjunct in hypervirulent/hypermucoviscous Klebsiella pneumoniae infections: a scoping review
Abstract
Background: Hypervirulent/Hypermucoviscous Klebsiella pneumoniae (HvKp/HmKp) is associated with invasive community-acquired infections and metastatic complications, with reports of clinical failure despite in vitro susceptibility to standard antibiotics. Rifampicin has been described in experimental settings to modulate virulence by suppressing the hypermucoviscous phenotype through RNA polymerase-dependent regulation of capsule-associated genes. This scoping review aimed to systematically map the available evidence evaluating rifampicin as a potential antivirulence adjunct in HvKp/HmKp infections.
Methods: This scoping review was conducted in accordance with the Joanna Briggs Institute methodology and reported following the PRISMA-ScR guidelines. A structured search of PubMed/MEDLINE, Embase, Scopus, and the Cochrane Library was performed from database inception to May 2026 using predefined terms related to hypervirulence, Klebsiella pneumoniae, and rifampicin/rifampin. The search was supplemented by grey literature and reference list screening. Studies evaluating rifampicin in phenotypically, genotypically, or syndromically defined HvKp were eligible, including experimental and clinical reports describing rifampicin as adjunctive or salvage therapy. Data were charted and synthesized narratively to map study characteristics, proposed mechanisms, and reported outcomes.
Results: Of 1,361 records identified, 11 studies met the inclusion criteria, comprising four…
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