Klebsiella species

MICROBIOLOGY

• Gram-negative, aerobic bacilli of Enterobacteriaceae family.
  
  • Human pathogens: K. pneumoniae, K. oxytoca, K. rhinoscleromatis, and K. granulomatis.
  • Forms highly mucoid colonies w/ polysaccharide capsule, a virulence factor that inhibits phagocytosis. Easily cultured on non-selective media for sterile specimens or MacConkey agar for contaminated specimens.
• Resistance issues:
  • Beta-lactamases are constitutive, usually produced at low levels, and provide resistance against ampicillin, amoxicillin and ticarcillin. Few klebsiellae lack these beta-lactamases.
  • Extended-spectrum beta-lactamases (ESBLs) are plasmid-mediated, confer multidrug resistance (TEM or SHV types), and are detected by in vitro resistance to ceftazidime and aztreonam. CTX-M type ESBLs, which hydrolyze ceftazidime much less than other 3rd and 4th generation cephalosporins, are becoming more prevalent.
  • Klebsiella pneumoniae carbapenemases (KPC), Ambler Class A beta-lactamases, confer broad resistance and are associated with mortality rate >50%. Many isolates are a single sequence type, ST258. Most remain susceptible to gentamicin, tigecycline and colistin.
  • Metallo-beta-lactamases (Ambler Class B) include: IMP (imipenemase), VIM (Verona integron-encoded MBL), and NDM-1 (New Delhi MBL). NDM-1 generally resistant to all antibiotics except tigecycline and colistin.
  • OXA-type carbapenemases (Ambler Class D) include OXA-48, weakly hydrolyze carbapenems, broad-spectrum cephalosporins and aztreonam, but express resistance or decreased susceptibility to carbapenems.