What are the implications of Klebsiella (a type of bacteria) in urine?

From the Guidelines

Klebsiella in urine is a complicated urinary tract infection (UTI) that requires prompt antibiotic treatment, with a recommended treatment duration of 7 to 14 days, depending on the severity of the illness and local resistance patterns. The management of Klebsiella UTI involves appropriate treatment of the underlying complicating factor, as well as optimal antimicrobial therapy, which should be tailored based on the severity of the illness, local resistance patterns, and specific host factors, such as allergies 1.

Key Considerations

• The microbial spectrum of complicated UTIs, including Klebsiella, is greater than for uncomplicated UTIs, and antimicrobial resistance is more likely 1.
• A urine culture and susceptibility testing should be performed to guide the selection of an appropriate antimicrobial agent for the uropathogen isolated 1.
• Initial empiric therapy should be tailored and followed by (oral) administration of an appropriate antimicrobial agent for the uropathogen isolated 1.

Treatment Approach

• The treatment duration for Klebsiella UTI is generally recommended to be 7 to 14 days, but the duration should be closely related to the treatment of the underlying abnormality 1.
• When the patient is haemodynamically stable and has been afebrile for at least 48 hours, a shorter treatment duration (e.g., 7 days) may be considered in cases for which short-course treatment is desirable owing to relative contraindications to the antibiotic administered 1.
• Patients with complicated UTIs, including those caused by Klebsiella, should be closely monitored for signs of treatment failure or resistance, and adjustments to the treatment regimen should be made as needed 1.

From the FDA Drug Label

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 URINARY TRACT INFECTIONS (complicated and uncomplicated) Caused by Escherichia coli, Proteus mirabilis, Proteus vulgaris, Morganella morganii or Klebsiella pneumoniae

Klebsiella in urine can be treated with ciprofloxacin (PO) 2 or ceftriaxone (IV) 3, as both drugs are indicated for the treatment of urinary tract infections caused by Klebsiella pneumoniae.

• Ciprofloxacin (PO) is effective against Klebsiella pneumoniae in urinary tract infections.
• Ceftriaxone (IV) is also effective against Klebsiella pneumoniae in urinary tract infections, including complicated and uncomplicated cases.

From the Research

Klebsiella in Urine

• Klebsiella pneumoniae is a common cause of healthcare-associated urinary tract infections (UTIs) 4, 5, 6
• The treatment of Klebsiella UTIs can be challenging due to the increasing resistance to antibiotics 4, 5, 6, 7, 8
• Studies have shown that the use of certain antibiotics, such as aminoglycosides, can be effective in treating Klebsiella UTIs 5
• However, the choice of antibiotic therapy should be guided by susceptibility testing to ensure the best possible outcome 4, 5, 6, 7, 8
• The use of new antibiotic drugs, such as cefiderocol, meropenem-vaborbactam, and ceftazidim-avibactam, may also be effective in treating Klebsiella UTIs 6
• It is essential to note that the treatment of Klebsiella UTIs should be individualized based on the specific strain type and antibiotic susceptibility profile 5

Antibiotic Resistance

• Klebsiella pneumoniae has developed resistance to many antibiotics, including third-generation cephalosporins 7
• The use of extended-spectrum β-lactamases (ESBLs) has contributed to the increasing resistance to antibiotics 7
• Studies have shown that the use of antibiotics, such as ciprofloxacin and piperacillin/tazobactam, may not be effective in treating Klebsiella UTIs due to resistance 7, 8
• The development of new antibiotic drugs and the use of combination therapy may help to combat antibiotic resistance 6

Treatment Outcomes

• The treatment outcomes of Klebsiella UTIs can vary depending on the choice of antibiotic therapy and the strain type of the bacteria 5
• Studies have shown that the use of certain antibiotics, such as aminoglycosides, can be associated with better treatment outcomes 5
• However, the treatment outcomes can also be influenced by other factors, such as the severity of the infection and the presence of underlying medical conditions 5, 7