Klebsiella infections

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at September 1, 2016
StartDiseasesKlebsiella infections

Klebsiella infections are caused by bacteria and include several different types of hospital-acquired infections. Among these are pneumonia, meningitis, bloodstream infections (bacteremia), urinary tract infections (UTI's), and surgical site infection or infection of postoperative wounds.

Contents

Definition & Facts

Klebsiella bacteria are a type of CRE bacteria (carbapenem-resistant enterobacteriaceae) which means they are resistant to the carbapenem class of antibiotics. The people most susceptible to this bacterium are those who are hospitalized and receiving treatment for other infections, especially patients with weakened immune systems.

This organism normally resides inside the intestines where it doesn't cause disease. It can also be found in human feces and in soil. Problems result when this bacteria invades areas of the body like the brain, blood, and lungs.

Symptoms & Complaints

The symptoms of Klebsiella infections vary according to where the bacteria are located. Those suffering from pneumonia caused by Klebsiella bacteria will have chills, fever, coughing, flu-like symptoms, and difficulty breathing.

Those who have meningitis brought on by the Klebsiella bacterium will have fever, a stiff neck, and sensitivity to light. A patient who was infected with the bacterium through the use of a urinary catheter and is suffering from a urinary tract infection may experience fever, chills, back pain or abdominal pain, blood in the urine (hematuria), and vomiting.

If a patient has had a surgical procedure, and swelling, redness, or other color changes of the surgical wound site occurs, then a Klebsiella infection should be suspected. Most Klebsiella infections occur in healthcare settings such as nursing homes, hospitals, and surgery clinics. Caregivers should take note of fever, lethargy, and areas of redness, soreness, or swelling that aren't healing.

Causes 

Klebsiella infection is spread by direct contact, requiring the use of strict safety precautions for healthcare professionals including thorough hand washing and wearing gloves when treating infected patients. Contaminated medical equipment can also spread Klebsiella, meaning those on ventilators or using catheters could be at risk if proper sanitation procedures are not followed. It is unclear how long the bacteria can stay alive on surfaces.

People who are taking long courses of antibiotics have an increased risk of contracting Klebsiella infections, as are diabetics and those suffering from chronic alcoholism or lung disease.

When the Klebsiella bacteria enter the body, infection can occur. Hospitalization, especially when the patient is using an invasive device, such as an intravenous catheter or ventilator, can provide conditions that make it easier for this bacteria to enter. The likelihood of infection with the bacteria increases if the patient uses the invasive device for an extended period of time.

Because surgical procedures open up the body, they provide another way for Klebsiella to enter. Surgery combined with inadequate infection control procedures increases this risk. Patients whose immune systems are weak are also more prone to infection. The overuse of antibiotics may be developing strains of Klebsiella bacteria that are resistant to treatment.

Diagnosis & Tests

People with infections living in long-term care facilities, or in an outbreak area will be suspected of having the Klebsiella bacterium. Relatively easy to diagnose, Klebsiella will be identified using a sample of infected tissue, blood, sputum, lung secretions, and/or urine for a lab culture. These bacteria are easy to identify using a Gram-stain which will show how the bacteria reacts to certain dyes.

All bacteria are either gram-negative or gram-positive, depending on their reaction, with Klebsiella being gram-negative. After the sample is stained and cultured, it can be examined under a microscope. The Klebsiella organism can then be identified. Positron emission tomography (PET) scans and chest X-rays may also be used to evaluate lung infections. When the Klebsiella bacteria is suspected, intravenous catheters, urinary catheters, and breathing machines can also be tested for its presence. 

Treatment & Therapy

The recommended treatment has changed as the Klebsiella organism has developed resistances. The choice of antibiotic to use depends on which ones have been effective in the area in which the patient lives and on the part of the body with the infection. For patients with severe infections, the proper use of a two to three-day course of a combination of powerful antibiotics, followed by a switch to a specific one once the susceptibility pattern is known for the specific patient may be prescribed.

Antibiotics that may be used include aminoglycosides, polymyxins, tigecycline, fosfomycin, and temocillin. If the physician does prescribe an antibiotic, it is important for the patient to take the medication exactly as directed and to continue taking the prescribed course, even if the symptoms are gone. If treatment ends too soon, some bacteria may survive and the patient may become infected again.

Phage therapy is sometimes used as a supplement or alternative to the use of antibiotics. Simply put, a bacteriophage is a virus that destroys bacteria. Advantages of phage therapy include its effectiveness against drug-resistant bacteria, the fact that it only requires one dose of treatment, and the fact that it is usually well-tolerated. Clinical trials involving phage treatment have been encouraging. 

Prevention & Prophylaxis

Those who have been exposed to this bacteria can cause its spread if they do not take proper precautions. Strict cleaning procedures must be followed in healthcare environments in order to prevent the threat of contracting Klebsiella infections.

Diligent hand washing procedures must be enforced. Hand washing should occur before and after eating, before touching areas of the face where the bacteria could enter (such as the eyes, nose, and mouth), before and after changing bandages, before and after using the restroom, after coughing and sneezing, or after touching doorknobs, bed rails, remote control devices, or telephones.

Other precautions include a strict enforcement of the wearing of gloves and gowns when entering the room of a patient who has this infection. Medical devices should be meticulously cleaned and sterilized before each use