From the Guidelines
The typical source of Klebsiella bacteremia is the gastrointestinal tract, particularly the colon, where Klebsiella species naturally colonize, as well as urinary tract infections, especially in patients with indwelling urinary catheters or those with urinary tract abnormalities, and respiratory infections, including hospital-acquired pneumonia, particularly in immunocompromised patients or those on mechanical ventilation. According to the most recent evidence from 1, the management of infections caused by multidrug-resistant bacteria, including Klebsiella, should prioritize the use of novel β-lactam agents such as ceftazidime/avibactam and meropenem/vaborbactam as first-line treatment options for infections caused by KPC-producing carbapenem-resistant Enterobacterales (CRE). Some key points to consider in the management of Klebsiella bacteremia include:
- The gastrointestinal tract, urinary tract, and respiratory tract are common sources of infection
- Risk factors for developing Klebsiella bacteremia include diabetes mellitus, alcoholism, malignancy, and prolonged hospitalization
- Empiric therapy often includes broad-spectrum antibiotics such as carbapenems, with therapy narrowed based on susceptibility testing results
- The use of ceftazidime/avibactam and meropenem/vaborbactam is recommended for the treatment of infections caused by KPC-producing CRE, with consideration of the site of infection and local epidemiology
- Imipenem/relebactam and cefiderocol may also be considered as potential alternatives for the treatment of infections involving KPC-producing CRE, although clinical studies of their efficacy in these patients are limited. It is essential to note that the management of Klebsiella bacteremia should be guided by the most recent and highest-quality evidence, and that local epidemiology and resistance patterns should be taken into account when selecting empiric therapy.
From the Research
Typical Source of Klebsiella Bacteremia
The typical source of Klebsiella bacteremia can vary, but some common sources include:
- Urinary tract infections (UTIs) 2, 3
- Pneumonia 2, 4
- Intra-abdominal infections 5, 6
- Catheter-associated urinary tract infections (CAUTIs) 3
Community-Acquired vs. Hospital-Acquired Infections
Community-acquired Klebsiella bacteremia (CAKB) and hospital-acquired Klebsiella bacteremia (HAKB) have different underlying sources:
- CAKB: often associated with UTIs (58% of cases) 2
- HAKB: often associated with pneumonia (25% of cases) and more likely to result in serious manifestations of illness, such as shock and respiratory failure 2
Virulence Factors and Molecular Epidemiology
Klebsiella pneumoniae strains can exhibit various virulence factors, including: