Video:Klebsiella pneumoniae

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Description

Klebsiella pneumoniae is a Gram-negative, non-motile, encapsulated, lactose-fermenting, facultative anaerobic, rod-shaped bacterium. It appears as a mucoid lactose fermenter on MacConkey agar. Although found in the normal flora of the mouth, skin, and intestines,[1] it can cause destructive changes to human and animal lungs if aspirated, specifically to the alveoli resulting in bloody, brownish or yellow colored jelly like sputum. In recent years, Klebsiella species have become important pathogens in nosocomial infections.[2][3]K. pneumoniae can be treated with antibiotics if the infections are not drug-resistant.[4]

Presentation

Individuals with Klebsiella pneumonia tend to cough up a characteristic sputum, as well as having fever, nausea, tachycardia, and vomiting. Klebsiella pneumonia tends to affect people with underlying conditions, such as alcoholism.[5]

Complications

In terms of complications due to K. pneumoniae we find bacteremia, and lung abscesses.[6]

Cause

K. pneumoniae is from the Enterobacteriaceae family and is a bacteria which is gram-negative, encapsulate, and non-motile . [6]

Transmission

To get a K. pneumoniae infection, a person must be exposed to the bacteria. In other words, K. pneumoniae must enter the respiratory tract to cause pneumoniae, or the blood to cause a bloodstream infection. In healthcare settings, K. pneumoniae bacteria can be spread through person-to-person contact.[7]

Mechanism

In terms of the pathophysiology of Klebsiella pneumonia we see neutrophil myeloperoxidase defense against K. pneumoniae. Oxidative inactivation of elastase is involved, while LBP helps transfer bacteria cell wall elements to immune cells.[8][9][10]

Diagnosis

In terms of the diagnosis of Klebsiella pneumonia the following can be done to determine if the individual has this infection, including susceptibility testing for Extended Spectrum Beta-Lactamase, as well as,CBC, sputum (culture), radiography and CT scan[8][5].

Differential diagnosis

The differential diagnosis for Klebsiella pneumoniae includes, tuberculosis, Aspergillus infection, Acute respiratory distress syndrome (ARDS) and lung abscess.[6]

Prevention

Preventing Klebsiella pneumoniae infections, especially in healthcare settings, involves several key practices. To prevent spreading Klebsiella infections between individuals, healthcare personnel must follow strict adherence to hand hygiene preferably using an alcohol based hand rub or soap and water.[4]

Treatment

Treatment for Klebsiella pneumonia is by antibiotics such as aminoglycosides and cephalosporins, the choice of antibiotic depends upon the person's health condition, medical history and severity of the disease.[11][12]

Prognosis

The prognosis for Klebsiella pneumoniae infections, particularly pneumonia, can be serious; even with antibiotic therapy, the mortality rate ranges from 30 to 50 percent.[13] This is particularly true in those with alcohol use disorder, diabetes mellitus, nosocomial infection, or septicemia.[6]

Resistance 1

Klebsiella organisms are often resistant to multiple antibiotics. Current evidence implicates plasmids as the primary source of the resistance genes.[14] Klebsiella species with the ability to produce extended-spectrum beta-lactamases (ESBL) are resistant to virtually all beta-lactam antibiotics. Other frequent resistance targets include aminoglycosides, fluoroquinolones, tetracyclines, chloramphenicol, and trimethoprim/sulfamethoxazole.[15]

Resistance 2

Infection with carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae is emerging as an important challenge in health-care settings.[16][17] One of many CRE is carbapenem-resistant Klebsiella pneumoniae (CRKP). Over the past 10 years, a progressive increase in CRKP has been seen worldwide; however, this new emerging nosocomial pathogen is probably best known for an outbreak in Israel that began around 2006 within the healthcare system there.[18] In the U.S., it was first described in North Carolina in 1996;[19] since then CRKP has been identified in 41 states;[20] and is routinely detected in certain hospitals in New York and New Jersey.

Epidemiology 1

In Western civilization, 3 to 5 percent of community-acquired pneumonia is caused by K. pneumoniae. Worldwide K. pneumoniae accounts for about 12 percent of all hospital-acquired pneumonia.[6]

Epidemiology 2

In terms of the global prevalence of CRKP (resistant strains) in individuals with Klebsiella pneumoniae was about 28 percent. South Asia has the highest CRKP at 66 percent, and North America has the lowest at about 14 percent.[21]

Research

Research conducted at King's College, London has implicated molecular mimicry between HLA-B27 and two Klebsiella surface molecules as the cause of ankylosing spondylitis.[22]Multiple drug-resistant K. pneumoniae strains have been neutralized in vivo by intraperitoneal, intravenous, or intranasal administration of phages in laboratory tests.[23]

History

The genus Klebsiella was named after the German microbiologist Edwin Klebs (1834 to 1913).He is mainly known for his work on infectious diseases. His works paved the way for the beginning of modern bacteriology, and inspired Louis Pasteur and Robert Koch.[24][25][26][27]

References

  1. ↑ Ryan, KJ; Ray, CG, eds. (2004). Sherris Medical Microbiology (4th ed.). McGraw Hill. ISBN 978-0-8385-8529-0.
  2. ↑ Singh, Lavan; Cariappa, M.P.; Kaur, Mandeep (December 2016). "Klebsiella oxytoca: An emerging pathogen?". Medical Journal, Armed Forces India. 72 (Suppl 1): S59–S61. doi:10.1016/j.mjafi.2016.05.002. ISSN 0377-1237. Archived from the original on 3 October 2022. Retrieved 15 October 2022.
  3. ↑ Gundogan, N. (1 January 2014). "Klebsiella". Encyclopedia of Food Microbiology (Second Edition). Academic Press. pp. 383–388. ISBN 978-0-12-384733-1. Retrieved 15 October 2022.
  4. ↑ 4.0 4.1 "Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007". Centers for Disease Control and Prevention. 19 February 2021. Archived from the original on 19 October 2021. Retrieved 9 October 2021. Public Domain This article incorporates text from this source, which is in the public domain.
  5. ↑ 5.0 5.1 "Aspiration Pneumonia Symptoms. Treatment and Information | Patient". Patient. Archived from the original on 16 January 2017. Retrieved 13 January 2017.
  6. ↑ 6.0 6.1 6.2 6.3 6.4 Ashurst, John V.; Dawson, Adam (2024). "Klebsiella Pneumonia". StatPearls. StatPearls Publishing.
  7. ↑ "Carbapenem-resistant Enterobacteriaceae (CRE) Infection: Clinician FAQs". Cdc.gov. Archived from the original on 25 October 2017. Retrieved 25 October 2017.
  8. ↑ 8.0 8.1 Klebsiella Infections at eMedicine
  9. ↑ Li B, Zhao Y, Liu C, Chen Z, Zhou D (2014). "Molecular pathogenesis of Klebsiella pneumoniae". Future Microbiology. 9 (9): 1071–81. doi:10.2217/fmb.14.48. PMID 25340836.
  10. ↑ Schröder, Nicolas W. J.; Schumann, Ralf R. (2005). "Non-LPS targets and actions of LPS binding protein (LBP)". Journal of Endotoxin Research. 11 (4): 237–242. doi:10.1179/096805105X37420. ISSN 0968-0519.
  11. ↑ "Klebsiella species – GOV.UK". www.gov.uk. Archived from the original on 16 January 2017. Retrieved 13 January 2017.
  12. ↑ Wilson WC, Grande CM, Hoyt DB (2007). Trauma critical care. New York: Informa Healthcare. p. 444. ISBN 978-1-4200-1684-0. Archived from the original on 11 December 2021. Retrieved 13 January 2017.
  13. ↑ Chen, Juan; Li, Jiahui; Huang, Fangfang; Fang, Junjie; Cao, Yang; Zhang, Kai; Zhou, Hongwei; Cai, Jiachang; Cui, Wei; Chen, Chensong; Zhang, Gensheng (28 March 2023). "Clinical characteristics, risk factors and outcomes of Klebsiella pneumoniae pneumonia developing secondary Klebsiella pneumoniae bloodstream infection". BMC Pulmonary Medicine. 23 (1): 102. doi:10.1186/s12890-023-02394-8. ISSN 1471-2466.
  14. ↑ Hudson, Corey; Bent, Zachary; Meagher, Robert; Williams, Kelly (June 6, 2014). "Resistance Determinants and Mobile Genetic Elements of an NDM-1-Encoding Klebsiella pneumoniae Strain". PLOS ONE. 9 (6): e99209. Bibcode:2014PLoSO...999209H. doi:10.1371/journal.pone.0099209. PMC 4048246. PMID 24905728.
  15. ↑ Nathisuwan, S; Burgess, DS; Lewis, JS (August 2001). "Extended-Spectrum β-Lactamases: Epidemiology, Detection, and Treatment". Pharmacotherapy. 21 (8): 920–928. doi:10.1592/phco.21.11.920.34529. PMID 11718498. S2CID 73938823.
  16. ↑ Limbago, BM; Rasheed, JK; Anderson, KF; Zhu, W; et al. (December 2011). "IMP-Producing Carbapenem-Resistant Klebsiella pneumoniae in the United States". Journal of Clinical Microbiology. 49 (12): 4239–4245. doi:10.1128/JCM.05297-11. PMC 3233008. PMID 21998425.
  17. ↑ Ghaith, Doaa M.; Mohamed, Zeinat K.; Farahat, Mohamed G.; Aboulkasem Shahin, Walaa; Mohamed, Hadeel O. (March 2019). "Colonization of intestinal microbiota with carbapenemase-producing Enterobacteriaceae in paediatric intensive care units in Cairo, Egypt". Arab Journal of Gastroenterology. 20 (1): 19–22. doi:10.1016/j.ajg.2019.01.002. PMID 30733176. S2CID 73444389. Archived from the original on 2021-10-12. Retrieved 2021-10-09.
  18. ↑ Berrie, C (2007-04-04). "Carbapenem-resistant Klebsiella pneumoniae outbreak in an Israeli hospital". Medscape. Medical News. WebMD. Archived from the original on 2012-12-02. Retrieved 2013-07-07.
  19. ↑ Yigit, H; Queenan, AM; Anderson, GJ; Domenech-Sanchez, A; et al. (April 2001). "Novel carbapenem-hydrolyzing beta-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae". Antimicrobial Agents and Chemotherapy. 45 (4): 1151–1161. doi:10.1128/AAC.45.4.1151-1161.2001. PMC 90438.
  20. ↑ Vastag, Brian (2012-08-22). "'Superbug' stalked NIH hospital last year, killing six". The Washington Post. Archived from the original on 2012-12-23. Retrieved 2013-07-07.
  21. ↑ Lin, Xing-chen; Li, Chang-li; Zhang, Shao-yang; Yang, Xiao-feng; Jiang, Meng (1 February 2024). "The Global and Regional Prevalence of Hospital-Acquired Carbapenem-Resistant Klebsiella pneumoniae Infection: A Systematic Review and Meta-analysis". Open Forum Infectious Diseases. 11 (2). doi:10.1093/ofid/ofad649.
  22. ↑ Rashid, T; Ebringer, A (June 2007). "Ankylosing spondylitis is linked to Klebsiella – the evidence". Clinical Rheumatology. 26 (3): 858–864. doi:10.1007/s10067-006-0488-7. PMID 17186116. S2CID 43456525.
  23. ↑ Bogovazova, GG; Voroshilova, NN; Bondarenko, VM (April 1991). "The efficacy of Klebsiella pneumoniae bacteriophage in the therapy of experimental Klebsiella infection". Zhurnal Mikrobiologii, Epidemiologii, I Immunobiologii (in русский) (4): 5–8. ISSN 0372-9311. PMID 1882608.
  24. ↑ Köhler, W.; Mochmann, H. (1988). "[Edwin Klebs (1834-1913), pathologist and forerunner of bacteriology. In memory of the 75th anniversary of his death]". Zeitschrift Fur Arztliche Fortbildung. 82 (20): 1037–1042. ISSN 0044-2178. Archived from the original on 6 October 2022. Retrieved 6 October 2022.
  25. ↑ "Carl Friedländer (1847–87)". Nature. 160 (4072): 668–668. 1 November 1947. doi:10.1038/160668b0. ISSN 1476-4687. Archived from the original on 16 October 2022. Retrieved 13 October 2022.
  26. ↑ Garrison, F.H. (1913). "Edwin Klebs (1834-1913)". Science. 38 (991): 920–921. Bibcode:1913Sci....38..920G. doi:10.1126/science.38.991.920. JSTOR 1639550. PMID 17753538. Archived from the original on 2020-11-16. Retrieved 2022-10-14.
  27. ↑ Anonymous (1913). "Theodor Albrecht Edwin Klebs. Born Königsberg-i.-Pr., February 6, 1834-died Berne, October 23, 1913". The Journal of Pathology and Bacteriology. 18 (1): 401–403. doi:10.1002/path.1700180140.
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