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What is Klebsiella pneumoniae ssp pneumoniae?
Klebsiella is a type of gram-negative bacteria that can cause different types of healthcare-associated infections, including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis.
Klebsiella pneumoniae is a bacterium that normally lives inside human intestines, where it doesn't cause disease. But if K. pneumoniae gets into other areas of the body, it can lead to a range of illnesses:
→ urinary tract infections
→ skin and wound infections
→ liver abscesses
→ pneumonia
→ blood infections
→ meningitis
Most cases of K. pneumoniae infection occur in a hospital setting.
Klebsiella and antimicrobial resistance:
Increasingly, Klebsiella bacteria have developed antimicrobial resistance, most recently to the class of antibiotics known as carbapenems. Klebsiella bacteria are normally found in the human intestines (where they do not cause disease). They are also found in human stool (feces).
Some Klebsiella bacteria have become highly resistant to antibiotics. When bacteria such as Klebsiella pneumoniae produce an enzyme known as a carbapenemase (referred to as KPC-producing organisms), then the class of antibiotics called carbapenems will not work to kill the bacteria and treat the infection. Klebsiella species are examples of Enterobacterales, a normal part of the human gut bacteria, that can become carbapenem-resistant. CRE, which stands for carbapenem-resistant Enterobacterales, are an order of germs that are difficult to treat because they have high levels of resistance to antibiotics. Unfortunately, carbapenem antibiotics often are the last line of defense against Gram-negative infections that are resistant to other antibiotics.
Klebsiella in healthcare settings:
In healthcare settings, Klebsiella infections commonly occur among sick patients who are receiving treatment for other conditions. Patients whose care requires devices like ventilators (breathing machines) or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for Klebsiella infections. Healthy people usually do not get Klebsiella infections.
How Klebsiella bacteria are spread:
To get a Klebsiella infection, a person must be exposed to the bacteria. For example, Klebsiella must enter the respiratory (breathing) tract to cause pneumonia, or the blood to cause a bloodstream infection.
In healthcare settings, Klebsiella bacteria can be spread through person-to-person contact (for example, from patient to patient via the contaminated hands of healthcare personnel, or other persons) or, less commonly, by contamination of the environment. The bacteria are not spread through the air.
How to prevent Klebsiella from spreading:
To prevent spreading Klebsiella infections between patients, healthcare personnel must follow specific infection control precautions. These precautions may include strict adherence to hand hygiene and wearing gowns and gloves when they enter rooms where patients with Klebsiella–related illnesses are housed. Healthcare facilities also must follow strict cleaning procedures to prevent the spread of Klebsiella.
To prevent the spread of infections, patients also should clean their hands very often, including:
→ Before preparing or eating food
→ Before touching their eyes, nose, or mouth
→ Before and after changing wound dressings or bandages
→ After using the restroom
→ After blowing their nose, coughing, or sneezing
→ After touching hospital surfaces such as bed rails, bedside tables, doorknobs, remote controls, or the phone.
How to treat Klebsiella infections:
Klebsiella infections that are not drug-resistant can be treated with antibiotics. Infections caused by KPC-producing bacteria can be difficult to treat because fewer antibiotics are effective against them. In such cases, a microbiology laboratory must run tests to determine which antibiotics will treat the infection.
What should patients do if they have been diagnosed with a Klebsiella–related illness?
They must follow the treatment regimen prescribed by the healthcare provider. If the healthcare provider prescribes an antibiotic, patients must take it exactly as the healthcare provider instructs. Patients must complete the prescribed course of medication, even if symptoms are gone. If treatment stops too soon, some bacteria may survive and the patient may become reinfected. Patients must wash their hands as often as possible and follow all other hygiene recommendations.
Causes of elevated Klebsiella pneumoniae ssp:
The Klebsiella pneumonia bacteria can naturally reside in the gut and respiratory tract of healthy individuals. Infections rarely occur in people who have a healthy immune system.
Illness, antibiotic use, or a weak immune system increases the risk. Klebsiella pneumoniae is a leading cause of nosocomial infection (=originating in a hospital setting) among people of all ages, ranging from infants to older adults—that is, disease originating in the hospital.
Community-acquired Klebsiella pneumoniae can occur outside the hospital setting as community-acquired pneumonia, but this is rare. Such cases affect people who have a weak immune system, especially those who are alcohol-dependent or who have diabetes but can also occasionally cause disease in healthy hosts.
The bacteria are spread by direct contact, typically through contamination of ventilator equipment and catheters or other types of tubing in the healthcare setting. It can also spread from person to person by touch, but it is not known to spread through the air.
Klebsiella pneumoniae ssp and Urinary tract infections (UTI):
When K. pneumoniae enters the urinary tract, it can lead to a UTI. A UTI can affect any part of the urinary system, including the urethra, kidneys, bladder, and ureters. Symptoms include a strong, frequent need to urinate, burning sensation during urination, pelvic pain, and cloudy, bloody, or strong-smelling urine. Women are at a greater risk for UTIs than men.
As a gram-negative, encapsulated, non-motile bacterium, it is inherently resistant to multiple antibiotics, making its role in UTIs particularly concerning. Klebsiella pneumoniae primarily inhabits the gastrointestinal tract but can become opportunistic in immunocompromised individuals or when introduced into typically sterile areas like the urinary tract. UTIs caused by this bacterium are often more complicated to treat due to its resistance to commonly used antibiotics, such as penicillins and cephalosporins.
Klebsiella pneumoniae ssp (subspecies) is known for its thick, prominent capsule, which is a key virulence factor. This capsule helps the bacteria evade the host's immune response, allowing it to establish infection more effectively. When it infects the urinary tract, it can lead to a range of symptoms, from mild bladder infections (cystitis) to severe kidney infections (pyelonephritis). The presence of this bacterium in the urinary tract can be particularly dangerous in hospital settings, where it may cause nosocomial infections.
The treatment of UTIs caused by Klebsiella pneumoniae often requires the use of more potent antibiotics, such as carbapenems or aminoglycosides, which are reserved for more severe infections due to their potential side effects and the risk of further promoting antibiotic resistance.
References:
Cristea OM, Avramescu CS, Balasoiu M, Popescu FD, Popescu F, Amzoiu MO. Urinary tract infection with Klebsiella pneumoniae in Patients with Chronic Kidney Disease. Curr Health Sci J. 2017 Apr-Jun;43(2):137-148. doi: 10.12865/CHSJ.43.02.06. Epub 2017 Jun 29. PMID: 30595869; PMCID: PMC6284181.
Chapelle C, Gaborit B, Dumont R, Dinh A, Vallée M. Treatment of UTIs Due to Klebsiella pneumoniae Carbapenemase-Producers: How to Use New Antibiotic Drugs? A Narrative Review. Antibiotics (Basel). 2021 Nov 1;10(11):1332. doi: 10.3390/antibiotics10111332. PMID: 34827272; PMCID: PMC8615227.
Azimirad M, Tajbakhsh M, Yadegar A, Zali MR. Recurrent urinary tract infection with antibiotic-resistant Klebsiella pneumoniae in a patient with Crohn's disease: A case report. Clin Case Rep. 2021 Aug 11;9(8):e04531. doi: 10.1002/ccr3.4531. PMID: 34401151; PMCID: PMC8355749.
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