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Klebsiella Pneumoniae: A Superbug Found in Health Care Environments

  • Synopsis: Published: 2012-08-24 (Revised/Updated 2017-06-25) - Klebsiella pneumonia referred to as Friedlanders bacillus causes necrotizing lobar pneumonia and can be found in health care environments. For further information pertaining to this article contact: Ian Langtree at Disabled World.
Klebsiella Pneumoniae

Klebsiella is the genus name for a bacterium that is found in the intestinal, respiratory, and urogenital tracts of our body. Klebsiella pneumoniae belongs to the Enterobacteriaceae family of bacteria. It is rod shaped, non-motile, and a gram negative bacterium. The bacterium has a polysaccharide capsule that encloses it; this makes the treatment of Klebsiella pneumoniae extremely difficult, since, the capsule provides the bacteria with resistance to most anti-biotics - klebsiellapneumoniae.org

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Quote: "The reason for the high mortality rate is because necrotizing pneumonia is highly dangerous and people who are affected are often times chronically ill."

Klebsiella pneumonia, also referred to as, 'Friedlander's bacillus,' is a small Gram-negative coccobacilli that causes necrotizing lobar pneumonia and can be found in health care environments. It does not form spores, is motionless, and is capable of forming a capsule. K. pneumonia is found in the regular intestinal flora of people and is usually harmless in those who have weakened immune systems.

In weakening by other infections it might occur as pathogens. The most common diseases are infections involving a person's respiratory or urinary tracts. K. pneumonia is responsible for nosocomial pneumonia in, 'immunoincompetent,' people. The bacteria produce approximately 10% of all infections that are acquired in hospitals to include urinary tract infections, pneumonia, surgical wounds, and biliary tract wounds.

Others, particularly hospital or other health care environment staff members, are at a particular risk of K. pneumonia. The risk is especially high when resistant strains have colonized a person's throat, mouth, or intestines. People who are predisposed to K. pneumonia include those who use catheters, endotracheal tubes, alcoholics, people with diabetes, congestive heart failure, seniors, chronic obstructive pulmonary disease, immuno-suppression, or other forms of debilitating diseases. The combined mortality rate of primary and secondary K. pneumonia is as high as 50%.

The reason for the high mortality rate is because necrotizing pneumonia is highly dangerous and people who are affected are often times chronically ill. Pneumonia is marked by a sudden onset and is characterized by pleuritic pain, fever, and expectoration of thick mucus as the infection progresses. The most severe symptoms include cyanosis and respiratory distress, followed by the death of the person within two or three days.

People with K. pneumonia often cough up sputum with a resemblance to, 'red currant jelly.' The infection is ranked second only to E. coli where urinary tract infections and seniors are concerned. The infection is also an opportunistic pathogen in people with enteric pathogenicity, chronic lung disease, nasal and Mucosaatrphie rhinoscleroma. The most dangerous source of infection in health care environments is residues, followed by contact with instruments that have been contaminated with the infection.

Members of the Klebsiella class commonly express two types of antigens on their cell surface. The first O antigen is a, 'lipopolysaccharide,' that consists of nine different varieties. The second K antigen is a, 'capsular polysaccharide,' with greater than eighty different varieties. Both of these contribute to the pathogenicity and form the basis for sub-typing. Pneumonia is something that develops when the bacilli invade and then multiply within a person's alveolar spaces.

K. Pneumonia is more and more common because of increasing resistance to both ampicillin and penicillin. The infections also belong to the, 'ESBL-producing strains,' or, 'extended-spectrum beta-lactamase,' strains and is becoming more multi-resistant to numbers of broad-acting antibiotics including ceftazidime and cephalosporins. Many people get K. pneumonia when they are in a health care environment for any number of reasons. K. Pneumonia can be complicated by an often times fatal septicemia.

Preventing Klebsiella Pneumonia

Preventing this highly dangerous infection from spreading between people and health care workers involves following very specific infection control precautions. The precautions can include strictly adhering to the wearing of gloves and gowns and following hand washing hygiene when entering rooms where a person has the infection. Health care environments also need to follow very strict cleaning procedures to prevent the spread of K. pneumonia. In order to prevent the spread of this infection, people in health care environments need to wash their hands often as well as:

  • After using the restroom
  • Before preparing or eating food
  • Before touching their mouth, nose, or eyes
  • After coughing, sneezing, or blowing their nose
  • Before and after changing bandages or wound dressings
  • After touching hospital surfaces including bedside tables, doorknobs, bed rails, the phone, or remote controls

Drug Resistant K. Pneumonia

Unfortunately, some forms of K. Pneumonia have become very resistant to antibiotics. When bacteria such as K. pneumonia produce an enzyme known as, 'carbapenemase,' also referred to as, 'KPC-producing organisms,' the class of antibiotics known as, 'carbapenems,' will not work to kill the bacteria or treat the infection. The carbapenem antibiotics are many times the last line of defense against Gram-negative infections that have become resistant to other types of antibiotics.

Treatment of K. Pneumonia Infections

K. Pneumonia infections that are not drug-resistant can be treated using antibiotics. Infections that are caused by KPC-producing bacteria are hard to treat because there are fewer antibiotics that are effective against them. When a person has a hard to treat infection, a microbiology lab has to run tests to find out which antibiotics will treat the person's infection.

The recommended form of treatment for K. pneumonia has changed as the organism itself has developed resistances. The organisms are often resistant to many different antibiotics, and current evidence has implicated a plasmid as the source of the resistant genes. K. Pneumonia infections with the ability to produce ESBL-resistance to many entire classes of antibiotics now exist. The most common resistances include resistance to:

  • Tetracyclines
  • Aminoglycosides
  • Fluoroquinolones
  • Chloram-phenicol
  • Sulfamethoxazole-trimethoprim

The choice of a particular antimicrobial agent depends upon local susceptibility patterns, as well as the part of the person's body that is infected. For people who have severe infections treatment with an initial short course of combination therapy, followed by a change to a specific form of therapy after the susceptibility pattern becomes know for the person, is common. If the specific K. pneumonia a person has is not antibiotic resistant, antibiotics can be used to treat it.

Some doctors recommend the use of Meropenem for people with ESBL-producing K. pneumonia. Unfortunately, for people with these forms of K. pneumonia antibiotic use is often not enough. Surgical clearing, commonly done as interventional radiology drainage, is many times needed after the person is started on antimicrobial agents.

Family members of people who have a K. pneumonia infection have a low risk of acquiring the infection. A health care provider can order lab tests to find out if a K. pneumonia infection is drug-resistant. It is still necessary for everyone to follow precautions in health care environments today, especially hand washing. K. Pneumonia bacteria are spread most often through person-to-person contact and hand washing is the best way to prevent the spread of the infection.

Related Information:

  1. Preventing Transmission of Infectious Agents in Healthcare Settings - (PDF) - Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings.
  2. Urgent: What do we do Regarding the Dwindling Stock of Antibiotics- Washington University in St. Louis - (2014-10-10)
    https://www.disabled-world.com/medical/pharmaceutical/dwindling.php
  3. Carbapenem-Resistant Enterobacteriaceae (CRE), Bacteria and Infection - Thomas C. Weiss - (2015-02-23)
    https://www.disabled-world.com/health/cre-bacteria.php


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