Is Klebsiella pneumoniae a common cause of urinary tract infections (UTIs)?

Is Klebsiella pneumoniae Common in UTIs?

Yes, Klebsiella pneumoniae is a common cause of urinary tract infections, ranking as the second most frequent uropathogen after E. coli, accounting for approximately 15% of UTI cases. 1

Frequency and Clinical Context

• K. pneumoniae represents the second most common UTI pathogen after E. coli, which dominates at 60-87% of cases. 1

• In a recent Greek surveillance study (2017-2022), K. pneumoniae accounted for 14.8% of all Enterobacteriaceae isolated from urine specimens, with isolation frequency secondary only to E. coli (66.3%). 2

• K. pneumoniae is particularly prevalent in complicated UTIs rather than simple cystitis, where it is specifically listed among organisms associated with complicating factors. 3, 4

Healthcare vs. Community Settings

• Hospital-acquired UTIs show higher rates of K. pneumoniae compared to community-acquired infections, particularly in patients with:

  • Indwelling catheters or nephrostomy tubes 3
  • Recent hospitalization or instrumentation 3
  • Previous antibiotic exposure 3

• In intensive care units, K. pneumoniae is a leading cause of catheter-associated UTIs, sepsis, and complicated nosocomial infections. 5

• Community-acquired K. pneumoniae UTIs do occur but are less frequent and typically less resistant than hospital-acquired strains. 6

Resistance Patterns Matter Clinically

• The clinical significance of K. pneumoniae UTIs relates heavily to antimicrobial resistance, particularly ESBL production and carbapenem resistance. 3, 1

• ESBL-producing K. pneumoniae is specifically associated with complicated UTIs and requires different treatment approaches than susceptible strains. 1, 4

• Carbapenem-resistant K. pneumoniae (CRKP) infections carry 28-day mortality rates of 71.9% in ICU settings, compared to 37.5% for carbapenem-susceptible strains. 5

• Recent data shows resistance rates in K. pneumoniae UTIs reaching 41% for ciprofloxacin, 38% for trimethoprim-sulfamethoxazole, and 34% for nitrofurantoin. 2

Clinical Recognition

Ciprofloxacin is FDA-approved for UTIs caused by K. pneumoniae, confirming its established role as a common UTI pathogen. 7

The organism is explicitly listed in treatment guidelines for complicated UTIs alongside E. coli, Proteus, Pseudomonas, Serratia, and Enterococcus species. 3