Klebsiella pneumoniae- Lab Diagnosis, Treatment, Prevention

Table of Contents

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.

Indole Production Test	Negative (K. oxytoca is Indole positive)
Methyl-Red Test	Negative
Voges-Proskauer Test	Positive
Citrate Utilization Test	Positive
Hydrogen Sulfide Production (TSI)	Negative
Urea Hydrolysis Test	Positive
Lysine Decarboxylase Test	Positive
Arginine Dihydrolase Test	Negative
Ornithine decarboxylase test	Negative
Motility at 36 °C	Non-motile
D-Glucose (acid/gas)	Positive/Positive
D-mannitol fermentation	Positive
Sucrose fermentation	Positive
Lactose fermentation	Positive
D-sorbitol fermentation	Positive
Cellobiose	Positive
Esculin hydrolysis	Positive
Acetate Utilization Test	Positive
ONPG Test	Positive

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.

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.

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