Klebsiella pneumoniae- Lab Diagnosis, Treatment, Prevention

Klebsiella pneumoniae- Lab Diagnosis, Treatment, Prevention

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 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

 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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