Abstract：Objective To investigate the risk factors and clinical characteristics of lung abscess patients with high virulence Klebsiella pneumoniae infection to provide more reference for early identification of high virulence infection high-risk groups. Methods 35 lung abscess patients with Klebsiella pneumoniae infection were retrospectively chosen in the period from January 2019 to January 2022 and grouped according to the types of Klebsiella pneumoniae infection into high virulence group (23 cases) and classical group (12 cases). The clinical characteristics, imaging data, drug resistance and clinical characteristics of 2 groups were compared. The independent risk factors of highly virulent Klebsiella pneumoniae infection in lung abscess were evaluated by Logistic regression model multivariate method. Results The proportion of high virulence combination with diabetes mellitus, extrapulmonary abscess, multiple infections, respiratory tract infection as the first symptom and multiple abscess as indicated by imaging were significantly higher than classical group（P<0.05）. The proportion of indignant catheters and invasive procedures before infection in the high virulence group were significantly lower than classical group（P<0.05）. Multivariate analysis of Logistic regression model showed that combined diabetes were independent risk factors of highly virulent Klebsiella pneumoniae infection in lung abscess（P<0.05）. The drug resistance rates of cefuroxime, ceftriaxone, ceftazidime, cefepime, amoxicillin/clavulanate, piperacillin/tazobactam, cefoperazone/sulbactam and levofloxacin in high virulence group were significantly lower than classic group（P<0.05）. The proportions of virulence genotype aero and rmpA+aero in high virulence group were significantly higher than classic group（P<0.05）. Conclusion High virulence Klebsiella pneumoniae infection in lung abscess was closely related to diabetes mellitus. Meanwhile, the main virulence genotype of this infection was aero.