Klebsiella pneumonia

Last updated
Klebsiella pneumonia
Klebsiella pneumoniae 01.png
K. pneumoniae on a MacConkey agar plate.
Specialty Pulmonology   Blue pencil.svg
Causes Klebsiella pneumonia(bacteria) [1]
Diagnostic method CBC, Sputum(culture] [1] [2]
Treatment Antibiotics [3] [4]

Klebsiella pneumonia (KP) is a form of bacterial pneumonia associated with Klebsiella pneumoniae . [5] [1] It is typically due to aspiration and alcoholism may be a risk factor, though it is also commonly implicated in hospital-acquired urinary tract infections, and COPD (chronic obstructive pulmonary disease) individuals [2] [3]

Bacterial pneumonia is a type of pneumonia caused by bacterial infection.

<i>Klebsiella pneumoniae</i> species of bacterium

Klebsiella pneumoniae is a Gram-negative, non-motile, encapsulated, lactose-fermenting, facultative anaerobic, rod-shaped bacterium. It appears as a mucoid lactose fermenter on MacConkey agar.

Pulmonary aspiration

Pulmonary aspiration is the entry of material from the oropharynx or gastrointestinal tract into the larynx and lower respiratory tract. A person may either inhale the material, or it may be delivered into the tracheobronchial tree during positive pressure ventilation. When pulmonary aspiration occurs during eating and drinking, the aspirated material is often colloquially referred to as "going down the wrong pipe."

Contents

Signs and symptoms

Individuals with Klebsiella pneumonia tend to cough up a characteristic sputum, as well as having fever, nausea, tachycardia and vomiting. Klebsiella pneumonia tends to affect people with underlying conditions, such as alcoholism. [2]

Sputum mucus that is coughed up from the lower airways

Sputum is mucus and is the name used for the coughed-up material (phlegm) from the lower airways. In medicine, sputum samples are usually used for naked eye exam, microbiological investigations of respiratory infections, and cytological investigations of respiratory systems. It is critical that the patient not give a specimen that includes any mucoid material from the interior of the nose. Naked eye exam of sputum can be done at home by a patient in order to note the various colors. Any hint of yellow color suggests an airway infection. Such color hints are best detected when the sputum is viewed on a very white background such as white paper, a white pot, or a white sink surface. The more intense the yellow color, the more likely it is a bacterial infection.

Nausea medical symptom or condition

Nausea is an unpleasant, diffuse sensation of unease and discomfort, often perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged, and has been described as placing discomfort on the chest, upper abdomen, or back of the throat.

Tachycardia Heart rate that exceeds the normal resting rate

Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal or abnormal.

Cause

The cause of the condition Klebsiella pneumonia is Klebsiella pneumoniae which is gram-negative, as well as rod-shaped, glucose-fermenting, facultative anaerobic bacterium. [6] [7] [8]

Glucose A simple form of sugar

Glucose (also called dextrose) is a simple sugar with the molecular formula C6H12O6. Glucose is the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, using energy from sunlight. There it is used to make cellulose in cell walls, which is the most abundant carbohydrate. In energy metabolism, glucose is the most important source of energy in all organisms. Glucose for metabolism is partially stored as a polymer, in plants mainly as starch and amylopectin and in animals as glycogen. Glucose circulates in the blood of animals as blood sugar. The naturally occurring form of glucose is D-glucose, while L-glucose is produced synthetically in comparably small amounts and is of lesser importance.

Pathophysiology

In terms of the pathophysiology of Klebsiella pneumonia we see neutrophil myeloperoxidase defense against K P.Oxidative inactivation of elastase is involved, while LBP helps transfer bacteria cell wall elements to the cells. [1] [9]

Neutrophil

Neutrophils are the most abundant type of granulocytes and the most abundant type of white blood cells in most mammals. They form an essential part of the innate immune system. Their functions vary in different animals.

Myeloperoxidase protein-coding gene in the species Homo sapiens

Myeloperoxidase (MPO) is a peroxidase enzyme that in humans is encoded by the MPO gene on chromosome 17. MPO is most abundantly expressed in neutrophil granulocytes, and produces hypohalous acids to carry out their antimicrobial activity. It is a lysosomal protein stored in azurophilic granules of the neutrophil and released into the extracellular space during degranulation. Neutrophil myeloperoxidase has a heme pigment, which causes its green color in secretions rich in neutrophils, such as pus and some forms of mucus. The green color contributed to its outdated name verdoperoxidase.

Elastase

In molecular biology, elastase is an enzyme from the class of proteases (peptidases) that break down proteins. In particular, it is a serine protease.

Resistant strains

Multidrug-resistant KP Multidrug-resistant Klebsiella pneumoniaeand neutrophil.bmp.jpg
Multidrug-resistant KP

Klebsiella resistant strains have been recorded in USA with a roughly threefold increase in Chicago cases, [10] quarantined individuals in Israel, [11] United Kingdom and parts of Europe, possible ground zero, or location of emergence, is the India-Pakistan border. [12]

Chicago City in Illinois, United States

Chicago, officially the City of Chicago, is the most populous city in Illinois, as well as the third most populous city in the United States. With an estimated population of 2,716,450 (2017), it is the most populous city in the Midwest. Chicago is the principal city of the Chicago metropolitan area, often referred to as Chicagoland, and the county seat of Cook County, the second most populous county in the United States. The metropolitan area, at nearly 10 million people, is the third-largest in the United States, and the fourth largest in North America and the third largest metropolitan area in the world by land area.

United Kingdom Country in Europe

The United Kingdom (UK), officially the United Kingdom of Great Britain and Northern Ireland, and sometimes referred to as Britain, is a sovereign country located off the north-western coast of the European mainland. The United Kingdom includes the island of Great Britain, the north-eastern part of the island of Ireland, and many smaller islands. Northern Ireland is the only part of the United Kingdom that shares a land border with another sovereign state, the Republic of Ireland. Apart from this land border, the United Kingdom is surrounded by the Atlantic Ocean, with the North Sea to the east, the English Channel to the south and the Celtic Sea to the south-west, giving it the 12th-longest coastline in the world. The Irish Sea lies between Great Britain and Ireland. With an area of 242,500 square kilometres (93,600 sq mi), the United Kingdom is the 78th-largest sovereign state in the world. It is also the 22nd-most populous country, with an estimated 66.0 million inhabitants in 2017.

Europe Continent in the Northern Hemisphere and mostly in the Eastern Hemisphere

Europe is a continent located entirely in the Northern Hemisphere and mostly in the Eastern Hemisphere. It is bordered by the Arctic Ocean to the north, the Atlantic Ocean to the west and the Mediterranean Sea to the south. It comprises the westernmost part of Eurasia.

A strain known as Carbapenem-Resistant Klebsiella pneumonia (CRKP) [13] was estimated to be involved in 350 cases in Los Angeles county between June and December 2010. [14]

Los Angeles City in California

Los Angeles, officially the City of Los Angeles and often known by its initials L.A., is the most populous city in California, the second most populous city in the United States, after New York City, and the third most populous city in North America. With an estimated population of four million, Los Angeles is the cultural, financial, and commercial center of Southern California. The city is known for its Mediterranean climate, ethnic diversity, Hollywood and the entertainment industry, and its sprawling metropolis. Los Angeles is the largest city on the West Coast of North America.

Diagnosis

In terms of the diagnosis of Klebsiella pneumonia the following can be done to determine if the individual has this infection, including susceptibility testing for (ESBL) Extended Spectrum β-Lactamase, as well as: [1] [2]

Treatment

Treatment for Klebsiella pneumonia is by antibiotics such as aminoglycosides and cephalosporins, the choice depending upon the person’s health condition, medical history and severity of the disease. [3] [4]

Streptomycin(Aminoglycoside) Streptomycin-1ntb-xtal-3D-balls.png
Streptomycin(Aminoglycoside)
Cephalosporin (core structure) Cephalosporin core structure.svg
Cephalosporin (core structure)

Klebsiella possesses beta-lactamase giving it resistance to ampicillin, many strains have acquired an extended-spectrum beta-lactamase with additional resistance to carbenicillin, amoxicillin, and ceftazidime. The bacteria remain 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. However, colistin-resistant strains of K. pneumoniae have been reported in ICUs. [1] [15] [16] [17] In 2009, strains of K. pneumoniae with gene called New Delhi metallo-beta-lactamase ( NDM-1) that even gives resistance against intravenous antibiotic carbapenem, were discovered in India and Pakistan.Klebsiella cases in Taiwan have shown abnormal toxicity, causing liver abscesses in people with diabetes mellitus (DM), treatment consists of third generation cephalosporins.[ medical citation needed ]

History

Community-acquired pneumonia caused by Klebsiella pneumoniae may be called Friedländer's bacillus, after Carl Friedländer, a German pathologist and microbiologist [18]

See also

Related Research Articles

Beta-lactamase enzyme

Beta-lactamases are enzymes produced by bacteria that provide multi-resistance to β-lactam antibiotics such as penicillins, cephalosporins, cephamycins, and carbapenems (ertapenem), although carbapenems are relatively resistant to beta-lactamase. Beta-lactamase provides antibiotic resistance by breaking the antibiotics' structure. These antibiotics all have a common element in their molecular structure: a four-atom ring known as a β-lactam. Through hydrolysis, the lactamase enzyme breaks the β-lactam ring open, deactivating the molecule's antibacterial properties.

Broad-spectrum antibiotic type of antibiotic

The term broad-spectrum antibiotic can refer to an antibiotic that acts on the two major bacterial groups, gram-positive and gram-negative, or any antibiotic that acts against a wide range of disease-causing bacteria. These medications are used when a bacterial infection is suspected but the group of bacteria is unknown or when infection with multiple groups of bacteria is suspected. This is in contrast to a narrow-spectrum antibiotic, which is effective against only a specific group of bacteria. Although powerful, broad-spectrum antibiotics pose specific risks, particularly the disruption of native, normal bacteria and the development of antimicrobial resistance. An example of a commonly used broad-spectrum antibiotic is ampicillin.

Cephalosporin class of pharmaceutical drugs

The cephalosporins are a class of β-lactam antibiotics originally derived from the fungus Acremonium, which was previously known as "Cephalosporium".

Colistin chemical compound

Colistin, also known as polymyxin E, is an antibiotic produced by certain strains of the bacteria Paenibacillus polymyxa. Colistin is a mixture of the cyclic polypeptides colistin A and B and belongs to the class of polypeptide antibiotics known as polymyxins. Colistin is effective against most Gram-negative bacilli.

Multiple drug resistance (MDR), multidrug resistance or multiresistance is antimicrobial resistance shown by a species of microorganism to multiple antimicrobial drugs. The types most threatening to public health are MDR bacteria that resist multiple antibiotics; other types include MDR viruses, parasites. Recognizing different degrees of MDR, the terms extensively drug resistant (XDR) and pandrug-resistant (PDR) have been introduced. The definitions were published in 2011 in the journal Clinical Microbiology and Infection and are openly accessible.

Carbapenem group of β-lactam antibiotics

Carbapenems are a class of highly effective antibiotic agents commonly used for the treatment of severe or high-risk bacterial infections. This class of antibiotics is usually reserved for known or suspected multidrug-resistant (MDR) bacterial infections. Similar to penicillins and cephalosporins, carbapenems are members of the beta lactam class of antibiotics, which kill bacteria by binding to penicillin-binding proteins, thus inhibiting bacterial cell wall synthesis. However, these agents individually exhibit a broader spectrum of activity compared to most cephalosporins and penicillins. Furthermore, carbapenems are typically unaffected by emerging antibiotic resistance, even to other beta-lactams.

<i>Acinetobacter baumannii</i> species of bacterium

Acinetobacter baumannii is a typically short, almost round, rod-shaped (coccobacillus) Gram-negative bacterium. It can be an opportunistic pathogen in humans, affecting people with compromised immune systems, and is becoming increasingly important as a hospital-derived (nosocomial) infection. While other species of the genus Acinetobacter are often found in soil samples, it is almost exclusively isolated from hospital environments. Although occasionally it has been found in environmental soil and water samples, its natural habitat is still not known.

Cefoxitin chemical compound

Cefoxitin is a second-generation cephamycin antibiotic developed by Merck & Co., Inc. from Cephamycin C in the year following its discovery, 1972. It was synthesized in order to create an antibiotic with a broader spectrum. It is often grouped with the second-generation cephalosporins. Cefoxitin requires a prescription and as of 2010 is sold under the brand name Mefoxin by Bioniche Pharma, LLC. The generic version of Mefoxin is known as cefoxitin sodium.

β-Lactamase inhibitor Endogenous substances and drugs that inhibit or block the activity of beta-lactamases

Beta-lactamases are a family of enzymes involved in bacterial resistance to beta-lactam antibiotics. They act by breaking the beta-lactam ring that allows penicillin-like antibiotics to work. Strategies for combating this form of resistance have included the development of new beta-lactam antibiotics that are more resistant to cleavage and the development of the class of enzyme inhibitors called beta-lactamase inhibitors. Although β-lactamase inhibitors have little antibiotic activity of their own, they prevent bacterial degradation of beta-lactam antibiotics and thus extend the range of bacteria the drugs are effective against.

New Delhi metallo-beta-lactamase 1 chemical compound

New Delhi metallo-beta-lactamase 1 (NDM-1) is an enzyme that makes bacteria resistant to a broad range of beta-lactam antibiotics. These include the antibiotics of the carbapenem family, which are a mainstay for the treatment of antibiotic-resistant bacterial infections. The gene for NDM-1 is one member of a large gene family that encodes beta-lactamase enzymes called carbapenemases. Bacteria that produce carbapenemases are often referred to in the news media as "superbugs" because infections caused by them are difficult to treat. Such bacteria are usually susceptible only to polymyxins and tigecycline.

Plasmid-mediated resistance

Plasmid-mediated resistance is the transfer of antibiotic resistance genes which are carried on plasmids. The plasmids can be transferred between bacteria within the same species or between different species via conjugation. Plasmids often carry multiple antibiotic resistance genes, contributing to the spread of multidrug-resistance (MDR). Antibiotic resistance mediated by MDR plasmids severely limits the treatment options for the infections caused by Gram-negative bacteria, especially Enterobacteriaceae family. The global spread of MDR plasmids has been enhanced by selective pressure from antibiotic usage in human and veterinary medicine.

Multidrug resistant Gram-negative bacteria are a type of Gram-negative bacteria with resistance to multiple antibiotics. They can cause bacteria infections that pose a serious and rapidly emerging threat for hospitalized patients and especially patients in intensive care units. Infections caused by MDR strains are correlated with increased morbidity, mortality, and prolonged hospitalization. Thus, not only do these bacteria pose a threat to global public health, but also create a significant burden to healthcare systems.

Antibiotic resistance in gonorrhea

The Gonorrhea bacterium Neisseria gonorrhoeae has developed antibiotic resistance to many antibiotics.

Carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase-producing Enterobacteriaceae (CPE) are Gram-negative bacteria that are resistant to the carbapenem class of antibiotics, considered the drugs of last resort for such infections. They are resistant because they produce an enzyme called a carbapenemase that disables the drug molecule. The resistance can vary from moderate to severe. Enterobacteriaceae are common commensals and infectious agents. Experts fear CRE as the new "superbug". The bacteria can kill up to half of patients who get bloodstream infections. Tom Frieden, former head of the Centers for Disease Control and Prevention has referred to CRE as "nightmare bacteria". Types of CRE are sometimes known as KPC and NDM. KPC and NDM are enzymes that break down carbapenems and make them ineffective. Both of these enzymes, as well as the enzyme VIM have also been reported in Pseudomonas.

Ceftolozane/tazobactam chemical compound

Ceftolozane is a novel cephalosporin antibiotic, developed for the treatment of infections with gram-negative bacteria that have become resistant to conventional antibiotics. It was studied for urinary tract infections, intra-abdominal infections and ventilator-associated bacterial pneumonia. Ceftolozane is combined with the β-lactamase inhibitor tazobactam, which protects ceftolozane from degradation. Ceftolozane-tazobactam is indicated for the treatment of complicated urinary tract infections and complicated intra abdominal infections.

Ceftazidime/avibactam pharmaceutical drug

Ceftazidime/avibactam is a combination drug composed of ceftazidime, a cephalosporin antibiotic, and avibactam, a β-lactamase inhibitor. It is used for the treatment of serious bacterial infections.

MCR-1

The mobilized colistin resistance (mcr-1) gene confers plasmid-mediated resistance to colistin, one of a number of last-resort antibiotics for treating gram negative infections. mcr-1 is capable of horizontal transfer between different strains of a bacterial species and after discovery in November 2015 in E. coli from a pig in China it has been found in Escherichia coli, Salmonella enterica, Klebsiella pneumoniae, Enterobacter aerogenes, and Enterobacter cloacae. As of 2017, it has been detected in more than 30 countries on 5 continents in less than a year.

ESKAPE is an acronym encompassing the names of six bacterial pathogens commonly associated with antimicrobial resistance: ESKAPE is an acronym for their names and a reference to their ability to escape the effects of commonly used antibiotics through evolutionarily developed mechanisms, and also because it is a acronym made from the first letters of their scientific names:

References

  1. 1 2 3 4 5 6 Klebsiella Infections at eMedicine
  2. 1 2 3 4 "Aspiration Pneumonia Symptoms. Treatment and Information | Patient". Patient. Retrieved 13 January 2017.
  3. 1 2 3 "Klebsiella species – GOV.UK". www.gov.uk. Retrieved 13 January 2017.
  4. 1 2 Wilson WC, Grande CM, Hoyt DB (2007). Trauma critical care. New York: Informa Healthcare. p. 444. ISBN   978-1-4200-1684-0 . Retrieved 13 January 2017.
  5. Dorland's Dictionary of Medical Acronyms and Abbreviations (7th ed.). Elsevier Health Sciences. 2016. p. 233. ISBN   978-0-323-44254-1 . Retrieved 14 January 2017.
  6. Williamson MA, Snyder LM (2014). Wallach's Interpretation of Diagnostic Tests: Pathways to Arriving at a Clinical Diagnosis. Lippincott Williams & Wilkins. ISBN   978-1-4698-8741-8 . Retrieved 14 January 2017.Google books page number not offered
  7. Procop GW, Pritt B (2014). Pathology of Infectious Diseases: A Volume in the Series: Foundations in Diagnostic Pathology. Elsevier Health Sciences. p. 257. ISBN   978-1-4557-5384-0.
  8. "Klebsiella". MeSH. NCBI. Retrieved 14 January 2017.
  9. Li B, Zhao Y, Liu C, Chen Z, Zhou D (2014). "Molecular pathogenesis of Klebsiella pneumoniae". Future Microbiology. 9 (9): 1071–81. doi:10.2217/fmb.14.48. PMID   25340836.
  10. Bigongiari J (October 26, 2010). "Chicago sees drug-resistant bacteria spreading". VaccineNewsDaily.com.
  11. Siegel-Itzcovich J (26 October 2010). "Israelis hospitalized in India to be checked for 'bugs'". The Jerusalem Post.
  12. Ogundipe S (October 25, 2010). "New 'superbug' scare emerges from India, Pakistan". Vanguard.
  13. Petrosillo N, Giannella M, Lewis R, Viale P (2013). "Treatment of carbapenem-resistant Klebsiella pneumoniae: the state of the art". Expert Review of Anti-infective Therapy. 11 (2): 159–77. doi:10.1586/eri.12.162. PMID   23409822.
  14. Moisse K (March 25, 2011). "Deadly Antibiotic-Resistant Superbug Spreads in Southern California". ABC News.
  15. Sanchez GV, Master RN, Clark RB, Fyyaz M, Duvvuri P, Ekta G, Bordon J (January 2013). "Klebsiella pneumoniae antimicrobial drug resistance, United States, 1998–2010". Emerging Infectious Diseases. 19 (1): 133–6. doi:10.3201/eid1901.120310. PMC   3557979 . PMID   23260464.
  16. Antoniadou A, Kontopidou F, Poulakou G, Koratzanis E, Galani I, Papadomichelakis E, Kopterides P, Souli M, Armaganidis A, Giamarellou H (April 2007). "Colistin-resistant isolates of Klebsiella pneumoniae emerging in intensive care unit patients: first report of a multiclonal cluster". The Journal of Antimicrobial Chemotherapy. 59 (4): 786–90. doi:10.1093/jac/dkl562. PMID   17307769.
  17. "Klebsiella pneumoniae in Healthcare Settings". Centers for Disease Control and Prevention. Retrieved 13 January 2017.
  18. Zander DS, Farver CF (2016). Pulmonary Pathology: A Volume in Foundations in Diagnostic Pathology Series. Elsevier Health Sciences. p. 169. ISBN   978-0-323-46119-1 . Retrieved 14 January 2017.

Further reading

Classification
D
External resources