Is Klebsiella a Rare Pathogen in Central Line Infections?
No, Klebsiella is not a rare pathogen in central line-associated bloodstream infections (CLABSI), though it is less common than Gram-positive organisms. Klebsiella species account for approximately 3-5% of hospital-acquired bloodstream infections and are part of the expected spectrum of Gram-negative pathogens causing CLABSI 1.
Epidemiologic Context
Gram-negative bacteria, including Klebsiella, represent 20-25% of all catheter-related bloodstream infections, making them a substantial minority of CLABSI cases 1, 2. Within the Gram-negative category specifically:
- Klebsiella pneumoniae accounted for 4% of hospital-acquired BSIs during 1986-1989 and 3% during 1992-1999 in CDC surveillance data 1
- In oncology and hematology patients, Gram-negative bacteria (including E. coli, Pseudomonas aeruginosa, and Klebsiella spp.) collectively cause 20-25% of CRBSI 1
- The predominant pathogens remain Gram-positive cocci (60-70% of cases), with coagulase-negative staphylococci being most common at 37% 1
Clinical Significance Despite Lower Frequency
While numerically less common than staphylococcal infections, Klebsiella CLABSI carries important clinical implications:
- Antimicrobial resistance is a major concern, with increasing prevalence of extended-spectrum β-lactamase (ESBL)-producing strains that resist broad-spectrum cephalosporins and other commonly used agents 1
- Multidrug-resistant Klebsiella pneumoniae has been identified as a predominant cause of CLABSI in some institutional studies, particularly in ICU settings 3
- Carbapenem-resistant Klebsiella pneumoniae has emerged as a cause of healthcare-associated infections, including CLABSI 4
Risk Stratification for Gram-Negative Coverage
Empiric coverage for Gram-negative organisms including Klebsiella should be considered in specific high-risk scenarios 1:
- Severe illness, hemodynamic instability, or septic shock
- Neutropenic or immunocompromised patients
- Femoral catheter placement
- Prolonged catheterization (>1 week)
- ICU patients, where Klebsiella resistance rates are higher 5
Treatment Implications
When Klebsiella is isolated from blood cultures in the setting of a central line:
- Catheter removal is generally recommended for Gram-negative CRBSI 6, 7
- Treatment duration is typically 10-14 days of IV antibiotics after catheter removal 6
- Antibiotic selection must account for local resistance patterns, particularly ESBL production 1
Common Pitfall to Avoid
Do not dismiss Klebsiella as "just a contaminant" when isolated from central line blood cultures. Unlike coagulase-negative staphylococci (which may represent contamination), Gram-negative organisms including Klebsiella are rarely skin contaminants and typically represent true infection requiring catheter removal and appropriate antimicrobial therapy 1, 6.