From the Guidelines
Yes, Klebsiella is pathogenic, and it can cause various infections, including pneumonia, urinary tract infections, bloodstream infections, and wound infections, particularly in healthcare settings where they can spread between patients and often show resistance to multiple antibiotics. Klebsiella bacteria, particularly Klebsiella pneumoniae, are naturally found in the human intestinal tract and environment but become problematic when they enter other body sites.
Key Points
- Klebsiella infections are particularly concerning in healthcare settings where they can spread between patients and often show resistance to multiple antibiotics.
- Treatment typically involves antibiotics such as carbapenems, cephalosporins, aminoglycosides, or fluoroquinolones, though the specific regimen depends on susceptibility testing due to increasing antibiotic resistance.
- Some Klebsiella strains have developed resistance to nearly all available antibiotics, including carbapenem-resistant Klebsiella pneumoniae (CRKP), which represents a serious public health threat, as reported by 1.
- People with weakened immune systems, those using invasive medical devices, and patients on long-term antibiotics face higher risk of serious Klebsiella infections.
- The management of intra-abdominal infections caused by Klebsiella and other multidrug-resistant bacteria requires careful consideration of the patient's clinical condition, individual risk for infection by resistant pathogens, and local resistance epidemiology, as recommended by 1 and 1.
- New antibiotics such as ceftolozane/tazobactam and ceftazidime/avibactam have been approved for the treatment of complicated intra-abdominal infections, including those caused by ESBL-producing Enterobacteriaceae and P. aeruginosa, and may be valuable for preserving carbapenems, as noted by 1 and 1.
From the Research
Pathogenicity of Klebsiella
- Klebsiella species are known to cause a wide range of diseases, including pneumonia, urinary tract infections (UTIs), bloodstream infections, and sepsis 2.
- These infections are particularly problematic among neonates, the elderly, and immunocompromised individuals, and are associated with high morbidity and mortality 2.
- Klebsiella strains associated with these infections are considered hypervirulent, and the increasing isolation of multidrug-resistant strains has limited therapeutic options for treatment 2, 3.
Virulence Factors
- Klebsiella pneumoniae has developed sophisticated immune evasion strategies, including stealth strategies and active suppression of innate immune defenses, to overcome host responses and survive in tissues 2.
- The bacterium produces several virulence factors, such as adherence factors, capsule production, lipopolysaccharide presence, and siderophore activity, which contribute to its infectivity 4.
- The formation of biofilms on medical devices, such as urinary catheters, is also a major factor in K. pneumoniae infections 4.
Resistance and Epidemiology
- The emergence of carbapenemase-producing Klebsiella pneumoniae (CPKP) is a significant public health concern, with limited treatment options and high mortality rates 3, 5.
- The spread of CPKP strains is often linked to healthcare settings, particularly in intensive care units (ICUs), where patients are more vulnerable to infection 5, 6.
- The development of resistance to last-resort antibiotics, such as ceftazidime-avibactam, is a growing concern, and highlights the need for new therapeutic strategies and infection control measures 3, 6.