View source for Klebsiella pneumoniae

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{{Infobox_Disease |
  Name           = Klebsiella pneumoniae |
  Image          = |
  Caption        = |
  DiseasesDB     = 7181 |
  ICD10          = {{ICD10|B|96|1|b|95}}, {{ICD10|G|00|8|g|00}}, {{ICD10|J|15|0|j|09}}, {{ICD10|P|23|6|p|20}} |
  ICD9           = {{ICD9|041.3}}, {{ICD9|320.82}}, {{ICD9|482.0}} |
  ICDO           = |
  OMIM           = |
  MedlinePlus    = |
  eMedicineSubj  = med |
  eMedicineTopic = 1237 |
  MeshName       = Klebsiella+Infections |
  MeshNumber     = C01.252.400.310.503 |
}}
{{Taxobox
| color = lightgrey
| name = ''Klebsiella pneumoniae''
| image = Klebsiella_pneumoniae_01.png
| image_width = 240px
| image_caption = ''K. pneumoniae'' on a [[MacConkey agar|MacConkey]] [[agar plate]].
| regnum = [[Bacterium|Bacteria]]
| phylum = [[Proteobacteria]]
| classis = [[Gamma Proteobacteria]]
| ordo = [[Enterobacteriaceae|Enterobacteriales]]
| familia = [[Enterobacteriaceae]]
| genus = ''[[Klebsiella]]''
| species = '''''K. pneumoniae'''''
| binomial = ''Klebsiella pneumoniae''
| binomial_authority = (Schroeter 1886)<br>Trevisan 1887
}}
'''''Klebsiella pneumoniae''''' is a [[Gram-negative]], non-[[motile]], [[encapsulated]], [[lactose]] [[fermentation (biochemistry)|fermenting]], [[facultative anaerobic]], rod shaped [[bacterium]] found in the normal flora of the mouth, skin, and intestines.<ref name=Sherris>{{cite book | author = Ryan KJ; Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | publisher = McGraw Hill | year = 2004 | id = ISBN 0838585299 }}</ref>  It is clinically the most important member of the ''[[Klebsiella]]'' [[genus]] of [[Enterobacteriaceae]]; it is closely related to ''[[Klebsiella oxytoca|K. oxytoca]]'' from which it is distinguished by being indole-negative and by its ability to grow on both [[melezitose]] and [[3-hydroxybutyrate]].  It naturally occurs in the soil and about 30% of strains can [[nitrogen fixation|fix nitrogen]] in anaerobic condition.<ref name=Postgate_1998>{{cite book|author=Postgate J|year=1998|title=Nitrogen fixation, 3rd ed.|publisher=Cambridge University Press}}</ref> As a free-living [[diazotroph]], its nitrogen fixation system has been much studied.

New [[antibiotic resistance|antibiotic resistant]] strains of ''K. pneumoniae'' are appearing, and it is increasingly found as a [[nosocomial infection]].

== History ==

The Danish scientist [[Hans Christian Gram]] (1853&ndash;1938), developed the technique now known as [[Gram staining]] in 1884 to discriminate between ''K. pneumoniae'' and ''[[Streptococcus pneumoniae]]''.

''Klebsiella'' was named after the German bacteriologist [[Edwin Klebs]] (1834&ndash;1913).

Community-acquired pneumonia caused by ''Klebsiella pneumoniae'' may be called ''Friedländer's Pneumonia'', after [[Carl Friedländer]].


== Pathogenesis ==

''K. pneumoniae'' can cause bacterial [[pneumonia]], typically due to aspiration by alcoholics, though it is more commonly implicated in [[hospital]]-acquired urinary tract and wound [[infection]]s, particularly in [[Immunodeficiency|immunocompromised]] individuals. ''Klebsiella'' ranks second to ''[[Escherichia coli|E. coli]]'' for urinary tract infections in older persons.  It is also an [[Opportunistic infection|opportunistic pathogen]] for patients with chronic pulmonary disease, enteric pathogenicity, nasal mucosa atrophy, and [[rhinoscleroma]].  Feces are the most significant source of patient infection, followed by contact with contaminated instruments.

Members of the ''Klebsiella'' genus typically express 2 types of antigens on their cell surface.  The first, O antigen, is a lipopolysaccharide of which 77 varieties exist.  The second is K agent, a capsular polysaccharide with 9 varieties.  Both contribute to pathogenicity and form the basis for subtyping.

Research conducted at King's College, London has implicated molecular mimicry between HLA-B27 and two molecules in Klebsiella microbes as the cause of [[ankylosing spondylitis]].<ref name=Rashid_2006>{{cite journal |author=Rashid T, Ebringer A |title=Ankylosing spondylitis is linked to ''Klebsiella''-the evidence (Epub ahead of print)|journal=Clin Rheumatol |volume= |issue= |pages= |year=2006 |pmid=17186116}}</ref> As a general rule, Klebsiella infections tend to occur in people with a weakened immune system from improper diet. Many of these infections are obtained when a person is in the hospital for some other reason. The most common infection caused by Klebsiella bacteria outside the hospital is pneumonia.

Klebsiella pneumonia tends to affect people with underlying diseases, such as alcoholism, diabetes and chronic lung disease.

== Treatment ==

''Klebsiella'' possesses a chromosomal class A [[beta-lactamase]] giving it inherent resistance to [[ampicillin]]. Many strains have acquired an extended-spectrum beta-lactamase with additional resistance to [[carbenicillin]], ampicillin, [[quinolones]], and increasingly to [[ceftazidime]]. The bacteria remain largely susceptible to aminoglycosides and cephalosporins. Varying degrees of inhibition of the beta-lactamase with [[clavulanic acid]] have been reported. Infections due to multidrug-resistant Gram-negative pathogens in the ICU have invoked the re-emergence of colistin, an antibiotic that had rarely been used for decades. However, colistin-resistant strains of K. pneumoniae have been reported in Greek ICUs.<sup>4</sup>

===Antimicrobial regimen===
:* '''Klebsiella pneumoniae'''<ref>{{cite book | last = Bartlett | first = John | title = Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases | publisher = Jones and Bartlett Learning | location = Burlington, MA | year = 2012 | isbn = 978-1449625580 }}</ref>
::* 1. '''Severe, nosocomial infections'''
:::* 1.1 '''Non-ESBLs in pneumonia, sepsis, complicated UTI, or intra-abdominal infections'''
::::* Preferred regimen (1): [[Cefepime]] 2 g IV q8h 
::::* Preferred regimen (2): [[Ceftazidime]] 2 g IV q8h 
::::* Preferred regimen (3): [[Imipenem]] 500 mg IV q6h 
::::* Preferred regimen (4): [[Meropenem]] 1 g IV q8h 
::::* Preferred regimen (5): [[Piperacillin-tazobactam]] 4.5 g IV q6h {{and}} [[Aminoglycoside]] 
::::* Alternative regimen (1): [[Ceftriaxone]] 1 g IV q24h {{and}} [[Metronidazole]] 500 mg IV q6h or 1 g IV q12h
::::* Alternative regimen (2): [[Moxifloxacin]] 400 mg IV/PO q24h 
:::* 1.2 '''ESBLs in pneumonia, sepsis, complicated UTI, or intra-abdominal infections'''
::::* Preferred regimen (1): [[Imipenem]] 500 mg IV q6h 
::::* Preferred regimen (2): [[Meropenem]] 1 g IV q8h 
::::* Preferred regimen (3): [[Ertapenem]] 1 g IV q24h 
::::* Preferred regimen (4): [[Doripenem]] 500 mg IV q8h
::::* Note: In ESBLs, inconsistent activity is seen with aminoglycosides, fluoroquinolones, and piperacillin-tazobactam. Avoid cephalosporins.

== References ==

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{{Reflist|2}} 4. Antoniadou, A. et al. (2006). Colistin-resistant isolates of Klebsiella pneumoniae emerging in intensive care unit patients: first report of a multiclonal cluster. The Journal of Antimicrobial Chemotherapy. Retrieved on April 28, 2007 from http://jac.oxfordjournals.org/cgi/content/abstract/dkl562v1

== External links ==
{{wikispecies}}
{{commonscat|Klebsiella pneumoniae}}

* [http://medinfo.ufl.edu/year2/mmid/bms5300/bugs/klebpne.html Diseases, symptoms, diagnosis of ''K. pneumoniae''] (University of Florida)
* [http://www.bacteriamuseum.org/species/Kpneumoniae.shtml Virtual museum of bacteria page on ''K. pneumoniae'']
* [http://respiratory-lung.health-cares.net/pneumonia-complications.php What're the complications of pneumonia?] (health-cares.net)
* [http://www.emedicine.com/med/topic1237.htm Klebsiella Infection] (emedicine.com)
*[http://www.genomesonline.org/search.cgi?colcol=all&goldstamp=ALL&gen_type=ALL&org_name1=genus&gensp=Klebsiella&org_domain=ALL&org_status=ALL&size2=ALL&org_size=Kb&gen_gc=ALL&phylogeny2=ALL&gen_institution=ALL&gen_funding=ALL&gen_data=ALL&cont=ALL&gen_country=ALL&gen_pheno=ALL&gen_eco=ALL&gen_disease=ALL&gen_relevance=ALL&gen_avail=ALL&selection=submit+search Klebsiella Genome Projects] from [http://www.genomesonline.org Genomes OnLine Database]

[[Category:Enterobacteria]]

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