Abstract: Multidrug-resistant hypervirulent Klebsiella pneumoniae （MDR-HvKP） possesses dual characteristics of drug resistance and high virulence. Its evolutionary mechanisms mainly include the acquisition of drug-resistant plasmids by hypervirulent K. pneumoniae, the acquisition of virulence plasmids by multidrug-resistant K. pneumoniae and the formation of virulence-drug resistance hybrid plasmids. Mobile genetic elements （MGEs） play a key role in this process. In addition, regulatory systems such as PhoP/Q and Rcs also participate in evolutionary regulation. Currently, coping strategies such as strain isolation and identification, development of novel antibacterial drugs and phage therapy are being actively conducted. MDR-HvKP poses a high transmission risk and is challenging to treat clinically, posing severe challenges to clinical prevention and control. In-depth research on the formation mechanism of MDR-HvKP and the development of novel treatment strategies are of great significance for clinical prevention, control and treatment.