From the Guidelines
Klebsiella colonization refers to the presence of Klebsiella bacteria in a person's body, typically in the gut or respiratory tract, without causing an active infection.
Key Points
- Colonization is a state where the bacteria are present in the body, but not causing harm or symptoms.
- Klebsiella pneumoniae is a type of bacteria that can cause infections, particularly in people with weakened immune systems.
- Multidrug-resistant (MDR) Klebsiella pneumoniae is a concern in healthcare settings, as it can spread easily and is resistant to many antibiotics.
- Hand hygiene and contact precautions are crucial in preventing the transmission of MDR-Klebsiella pneumoniae in healthcare settings, as recommended by the ESCMID guidelines 1.
- Active screening cultures can help identify patients colonized with MDR-Klebsiella pneumoniae, allowing for targeted interventions to prevent transmission 1.
- Decolonization of MDR-GNB carriers is not routinely recommended due to the lack of long-term efficacy and potential risk of antibiotic resistance selection 1. Some studies have investigated the use of oral non-absorbable antibiotics, such as colistin and neomycin, to eradicate rectal ESBL-E carriage in hospital patients 1. However, the evidence is limited, and more research is needed to determine the effectiveness of decolonization strategies. In clinical practice, it is essential to prioritize infection control measures, such as hand hygiene and contact precautions, to prevent the transmission of MDR-Klebsiella pneumoniae, rather than relying on decolonization strategies alone 1.
From the Research
Definition of Klebsiella Colonization
Klebsiella colonization refers to the presence of Klebsiella bacteria on or within a host, such as the mucosal surfaces, gut, or other tissues, without necessarily causing an infection 2, 3. This colonization can be a precursor to infection, especially in individuals with compromised immune systems or other risk factors.
Risk Factors for Colonization and Infection
Several risk factors have been identified as contributing to Klebsiella colonization and subsequent infection, including:
- Local healthcare practices, antibiotic use and misuse, infection control procedures, nutrition, gender, and age 2
- Prior gut colonization, with infection often caused by the colonizing strain 4, 5
- Gut community structure, with differences in the gut microbiome between colonized patients who develop an infection and those who remain asymptomatic 4, 5
- Patient factors such as overall comorbidities, depression, and low albumin levels 6
Characteristics of Klebsiella Colonization
Klebsiella colonization can be characterized by:
- The ability of the bacteria to colonize mucosal surfaces and spread to other tissues, causing fatal infections 2
- The presence of siderophores, which allow the bacteria to sequester iron from the surrounding medium and transport it to the intracellular compartment 2
- The importance of the gut as a reservoir for infectious Klebsiella, with colonization often occurring in the intestinal tract 4, 5
- The potential for colonization to last from days to years, with resolution influenced by immune response, competition from other organisms, and antimicrobial use 3