Klebsiella pneumoniae in Healthcare Settings

General Information

Klebsiella [kleb−see−ell−uh] 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. 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). 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 pneumoniae, 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.

Patients in healthcare settings also may be exposed to Klebsiella when they are on ventilators (breathing machines), or have intravenous (vein) catheters or wounds (caused by injury or surgery). Unfortunately, these medical tools and conditions may allow Klebsiella to enter the body and cause infection.

Preventing Klebsiella from spreading

To prevent spreading Klebsiella infections between patients, healthcare personnel must follow specific infection control precautions (see: Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings 2007). 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

Drug-resistant Klebsiella

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 Enterobacteriaceae, a normal part of the human gut bacteria, that can become carbapenem-resistant.
CRE, which stands for carbapenem-resistant Enterobacteriaceae, are a family 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.

Treating 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 think they have a Klebsiella–related illness?

See a healthcare provider.

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 re-infected. Patients must wash their hands as often as possible and follow all other hygiene recommendations.

How would someone know if their Klebsiella infection is drug-resistant?

The healthcare provider will order laboratory tests to determine if the Klebsiella infection is drug-resistant.

Can a Klebsiella infection spread to the patient’s family members?

If family members are healthy, they are at very low risk of acquiring a Klebsiella infection. It is still necessary to follow all precautions, particularly hand hygiene. Klebsiella bacteria are spread mostly by person-to-person contact and hand hygiene is the best way to prevent the spread of germs.

Recommendations and Guidelines

For more information about prevention and treatment of HAIs, see the resources below:

• Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings
• Guidance for Control of Infections with Carbapenem-Resistant or Carbapenemase-Producing Enterobacteriaceae in Acute Care Facilities MMWR March 20, 2009 / 58(10);256-260