What is Klebsiella (Klebcilla)?

From the Guidelines

Klebsiella infections should be treated with oral Ciprofloxacin 500 mg or 750 mg twice daily for 14 days, or intravenous Ceftriaxone 2G once daily for 14 days, as recommended by the most recent guidelines 1.

Treatment Options

The treatment of Klebsiella infections depends on the severity of the infection and the susceptibility of the bacteria to antibiotics.

• For mild to moderate infections, oral antibiotics such as Ciprofloxacin or Amoxicillin-clavulanic acid may be used.
• For severe infections, intravenous antibiotics such as Ceftriaxone or Carbapenems may be necessary.

Antibiotic Resistance

Klebsiella bacteria have developed resistance to many antibiotics, including extended-spectrum beta-lactamase (ESBL) production and carbapenem resistance.

• ESBL-producing Klebsiella bacteria are resistant to many cephalosporins and penicillins.
• Carbapenem-resistant Klebsiella bacteria are resistant to many carbapenems, making treatment challenging.

Prevention Measures

Prevention measures include proper hand hygiene, contact precautions for infected patients, and appropriate antibiotic stewardship to limit resistance development.

• Healthcare workers should wash their hands regularly with soap and water or use an alcohol-based hand sanitizer.
• Infected patients should be isolated to prevent the spread of the bacteria to others.
• Antibiotics should be used judiciously and only when necessary to prevent the development of antibiotic-resistant bacteria.

Recent Guidelines

The most recent guidelines recommend the use of oral Ciprofloxacin or intravenous Ceftriaxone for the treatment of Klebsiella infections 1.

• The guidelines also recommend the use of combination therapy for severe infections, including the use of aminoglycosides or fluoroquinolones in addition to a beta-lactam antibiotic.
• The guidelines emphasize the importance of susceptibility testing to guide antibiotic therapy and prevent the development of antibiotic-resistant bacteria.

From the FDA Drug Label

Adult Patients: Urinary Tract Infections caused by Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Serratia marcescens, Proteus mirabilis, Providencia rettgeri, Morganella morganii, Citrobacter diversus, Citrobacter freundii, Pseudomonas aeruginosa, methicillin-susceptible Staphylococcus epidermidis, Staphylococcus saprophyticus, or Enterococcus faecalis LOWER RESPIRATORY TRACT INFECTIONS Caused by Streptococcus pneumoniae, Staphylococcus aureus, Haemophilus influenzae, Haemophilus parainfluenzae, Klebsiella pneumoniae, Escherichia coli, Enterobacter aerogenes, Proteus mirabilis or Serratia marcescens The answer to Klebcilla is that it is likely referring to Klebsiella, which is a type of bacteria.

• Klebsiella pneumoniae is listed as a susceptible organism for both ciprofloxacin 2 and ceftriaxone 3.
• Both drugs can be used to treat infections caused by Klebsiella pneumoniae, but the specific infection and patient population should be considered when choosing an antibiotic.

From the Research

Klebcilla Overview

• Klebsiella pneumoniae is a bacterium that colonizes mucosal surfaces of healthy humans and is responsible for a significant number of Gram-negative infections in hospitalized patients 4.
• It is compatible with acquiring antibiotic resistance elements, and mutations in various proteins can generate resistance to antibiotics 4.
• Klebsiella species can cause a wide range of diseases, including pneumonia, urinary tract infections, bloodstream infections, and sepsis, particularly among neonates, elderly, and immunocompromised individuals 5.

Antibiotic Resistance

• Klebsiella pneumoniae is often resistant to several antibiotics, making treatment difficult and leading to treatment failure and systemic dissemination 6.
• The emergence of multidrug-resistant strains has become a serious problem in the treatment of Klebsiella infections, and novel strategies to prevent and inhibit bacterial growth need to be developed 6.
• Combination therapy using available antibiotics can be effective in treating resistant strains, but proper management of antibiotic consumption in hospitals is crucial to reduce the emergence and proliferation of resistance to current antibiotics 4.

Clinical Characteristics and Antimicrobial Susceptibility

• The clinical characteristics and antimicrobial susceptibility of Klebsiella pneumoniae, Klebsiella variicola, and Klebsiella quasipneumoniae can vary, and accurate identification is necessary to understand the epidemiology of these species 7.
• Klebsiella pneumoniae was found to be less susceptible to certain antibiotics, such as ampicillin/sulbactam and piperacillin, compared to Klebsiella variicola and Klebsiella quasipneumoniae 7.
• The choice of treatment and Klebsiella pneumoniae strain type can impact clinical outcomes, with certain strain types, such as ST258A, associated with clinical failure 8.

Infection Biology and Virulence

• Klebsiella pneumoniae has sophisticated immune evasion strategies, including stealth strategies and active suppression of innate immune defenses, which enable it to overcome host responses and survive in tissues 5.
• The bacterium can form biofilms on medical devices, such as urinary catheters, which can lead to infections and make treatment challenging 6.
• Several virulence factors, including adherence factors, capsule production, lipopolysaccharide presence, and siderophore activity, contribute to Klebsiella pneumoniae infectivity 6.