Klebsiella pneumoniae- Lab Diagnosis, Treatment, Prevention

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Last Updated on January 12, 2020 by Sagar Aryal

Laboratory Diagnosis of Klebsiella pneumoniae

  • In the setting of pneumonia, infection with  K. pneumoniae is confirmed by either sputum culture analysis, blood culture analysis or midstream urine depending upon the illness.
  • The presence of gram-negative rods in Gram-stained smears suggests Klebsiella; they maybe capsulated and non-sporing.
  • Material is inoculated into blood agar and Mac Conkey agar medium and incubated aerobically.
  • Blood Agar: Mucoid, non-hemolytic colonies
  • MacConkey Agar: Mucoid, lactose-fermenting (pink colored) colonies
  • After pure cultures have been obtained by selecting colonies from aerobically incubated plates, they are identified by biochemical reactions and colony morphology.

Klebsiella pneumoniae- Lab Diagnosis, Treatment, Prevention

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Tests/reactions

Indole Production TestNegative (K. oxytoca is Indole positive)
Methyl-Red TestNegative
Voges-Proskauer TestPositive
Citrate Utilization TestPositive
Hydrogen Sulfide Production
(TSI)
Negative
Urea Hydrolysis TestPositive
Lysine Decarboxylase TestPositive
Arginine Dihydrolase TestNegative
Ornithine decarboxylase testNegative
Motility at 36 °CNon-motile
D-Glucose (acid/gas)Positive/Positive
D-mannitol fermentationPositive
Sucrose fermentationPositive
Lactose fermentationPositive
D-sorbitol fermentationPositive
CellobiosePositive
Esculin hydrolysisPositive
Acetate Utilization TestPositive
ONPG TestPositive

 Treatment of Klebsiella pneumoniae

  • Given the low occurrence of  K. pneumoniae pulmonary infections in the community, treatment of pneumonia should follow standard guidelines for antibiotic therapy.
  • Once infection with  K. pneumoniae is either suspected or confirmed, antibiotic treatment should be tailored to local antibiotic sensitivities.
  • Current regimes for community-acquired  K. pneumoniae pneumonia include a 14-day treatment with either a third or fourth generation cephalosporin as monotherapy or a respiratory quinolone as monotherapy or either of the previous regimes in conjunction with an aminoglycoside. 
  • For nosocomial infections, a carbapenem can be used as monotherapy until sensitivities are reported.
  • Surgery may be needed for patients who experience empyema, lung abscess, pulmonary gangrene, or respiratory tract obstruction following a Klebsiella infection.
  • Correction of posterior urethral valves in patients with reoccurring UTIs is a possibility or other abnormalities influenced by infection.
  • Nosocomial isolates of K. pneumoniae often display multidrug-resistance phenotypes that are commonly caused by the presence of extended-spectrum β-lactamases or carbapenemases, making it difficult to choose appropriate antibiotics for treatment.

Prevention of Infection

  • Klebsiella infections are most well-known in hospitals spread through person-to-person contact by contaminated hands of surrounded people in the hospitals, whether it be an employee or a patient.
  • Nurses who look after these patients should maintain strict infection control protocols to prevent the spread of the organism.
  • Hand washing is crucial for both medical personnel and visitors.
  • Nurses should only ensure that only devices are only used once to minimize transmission from contaminated devices.
  • The pharmacist should ensure that empirical antibiotic prescribing is not carried out, as this only leads to the development of drug resistance. 

References

  1. Murray, P. R., Rosenthal, K. S., & Pfaller, M. A. (2013). Medical microbiology.
  2. Philadelphia: Elsevier/Saunders.
  3. https://www.ncbi.nlm.nih.gov/books/NBK519004/
  4. https://microbewiki.kenyon.edu/index.php/Klebsiella_pneumoniae_pathogenesis
  5. https://www.ncbi.nlm.nih.gov/pubmed/25340836
  6. https://cmr.asm.org/content/11/4/589
  7. https://www.researchgate.net/publication/267731558_Molecular_pathogenesis_of_Klebsiella_pneumoniae
  8. https://microbeonline.com/klebsiella-pneumoniae-properties-virulence-diseases-diagnosis/
  9. https://www.uptodate.com/contents/microbiology-and-pathogenesis-of-klebsiella-pneumoniae-infection
  10. https://www.futuremedicine.com/doi/10.2217/fmb.14.48
  11. https://www.sciencedirect.com/topics/medicine-and-dentistry/klebsiella-pneumoniae

Klebsiella pneumoniae- Lab Diagnosis, Treatment, Prevention

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