The diagnosis, management and surveillance of Klebsiella spp.
Klebsiella species belong to the family Enterobacteriaceae. Klebsiella species are a type of gram negative rod shaped-bacteria that are found everywhere in the environment and also in the human intestinal tract (where they do not cause disease).
Within the genus Klebsiella, 2 common species are associated with the majority of human infections: Klebsiella pneumoniae and Klebsiella oxytoca
Both species are commonly associated with a range of healthcare-associated infections, including pneumonia, bloodstream infections, wound or surgical site infections and meningitis.
In healthcare settings, klebsiella infections are seen in vulnerable, immunocompromised and unwell patients who have other co-morbidities and who are receiving treatment for other conditions.
Patients in intensive care units, post- surgical patients and patients with intra-abdominal, pelvic or neurological co-morbidities are most at risk. These patients may also be ventilator (breathing machine) dependant, have indwelling vascular or urinary catheters and be subject to prolonged or repeated courses of antibiotics making them even more susceptible to klebsiella infections.
Invasive procedures such as intubation, venous cannulation and urinary catheterisation can be the source of entry of the organism into the body resulting in infection.
In healthcare settings, klebsiella infections are acquired endogenously (from the patient’s own gut flora) or exogenously from the healthcare environment. Patient to patient spread can occur via contaminated hands of healthcare workers or less commonly by contamination of the environment. Air- borne spread of klebsiella does not normally occur.
Diagnosis and management
Antimicrobial resistance and healthcare associated infections (AMRHAI) reference unit is the national reference laboratory for investigating antibiotic resistance in healthcare associated bacterial pathogens.
Guidance on preventing healthcare associated Gram-negative bacterial bloodstream infections is available from the NHS Improvement website.
An important feature of Klebsiella species is their ability to become resistant to a wide range of antibiotics. All Klebsiella species are resistant to amoxicillin. When treating klebsiella infections it is important determine their antibiotic sensitivity pattern.
Many klebsiellae are sensitive to cephalosporins, carbapenems and aminoglycosides. However there is now emerging resistance and if the klebsiella causing infection is able to produce enzymes called extended spectrum beta lactamases they will be resistant to cephalosporins. When klebsiellae produce an enzyme known as a carbapenemase, this renders them resistant to the carbapenems.
By acquiring a combination of resistant mechanisms Klebsiella species can become multi-drug resistant.
The carbapenem group of antibiotics are most often the last line of defence against Gram-negative infections that are resistant to other antibiotics.
The single most important measure to prevent the acquisition and spread of infections with Klebsiella species in healthcare settings is to maintain a high degree of hand hygiene discipline among all groups of healthcare staff.
Equally important is the need to prevent acquisition and spread of multi-drug resistance and this can be achieved by a comprehensive infection prevention and control policy and antimicrobial stewardship.
Use the enhanced surveillance form to report mandatory surveillance of Gram-negative bacteria.
From April 2017, the government extended the surveillance of bacteraemias caused by Gram-negative organisms to include Klebsiella spp. This is in addition to the existing E. coli collection intended to reduce infections by 50% by 2021. Read NHS Improvement’s plans to reduce these infections.
This extended surveillance of Klebsiella spp. was mandated in September 2017 and included a requirement to backdate surveillance to April 2017, read supporting you to reduce Gram-negative infection rates.. In response to this, Klebsiella spp. data will be included in our mandatory surveillance publications from October 2017. See Gram-negative bacteraemia infections updates on the HCAI Data Capture System (DSC) Help and Support page for details.
Patient-level data of any Klebsiella spp bloodstream infections are reported monthly to Public Health England (PHE). Klebsiella spp. bacteraemia: voluntary surveillance in England, Wales and Northern Ireland