Health protection – guidance

Klebsiella species

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

Antimicrobial resistance and healthcare associated infections (AMRHAI) reference unit

Treatment

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.

Extended-spectrum beta-lactamases (ESBLs): treatment, prevention, surveillance

Carbapenem resistance: management and prevention

Prevention

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.

Carbapenemase-producing Enterobacteriaceae tool kit

NICE antimicrobial stewardship guidance

World Health Organization 5 moments of hand hygiene

Extended-spectrum beta-lactamases (ESBLs): treatment, prevention, surveillance

Carbapenem resistance: management and prevention

Epidemiology

Klebsiella spp. bacteraemia: voluntary surveillance