eMedicine Specialties > Infectious Diseases > Bacterial Infections

Klebsiella Infections: Follow-up

Author: Obiamiwe Umeh, MBBS, Fellow, Center for AIDS Research and Education, David Geffen School of Medicine at UCLA
Coauthor(s): Leonard B Berkowitz, MD, Chief, Divisions of Infectious Diseases and HIV/AIDS Services, Brooklyn Hospital Center; Clinical Assistant Professor, Department of Medicine, State University of New York at Brooklyn
Contributor Information and Disclosures

Updated: May 15, 2009

Follow-up

Transfer

  • Transfer patients with serious infections to a tertiary care facility.

Deterrence/Prevention

  • Follow hospital protocols for infection control to limit the spread of infection and resistant organisms. Restricting certain antibiotic use for specific indications and duration may help prevent the spread of resistant organisms.
  • Proper hand washing is crucial to prevent transmission from patient to patient via medical personnel. Contact isolation should be used for patients colonized or infected with highly antibiotic–resistant Klebsiella strains, such as ESBL-producing organisms.
  • Single-use devices may minimize transmission from contaminated equipment.
  • Contaminated nebulizers are a major source of hospital-acquired infection; this source has been eliminated through the use of disposable devices.
  • Use of protective isolation is generally not recommended. Outbreaks of diarrhea associated with Klebsiella infection in neonatal nurseries should necessitate isolation of affected infants.
  • Other suggested measures to prevent nosocomial infections include the following:
    • Remove medical devices (eg, catheters, tubes) when no longer needed.
    • Use nonalkalinizing gastric cytoprotective agents.
    • Place intubated patients in a semirecumbent position.
    • When possible, consider decreasing the duration and intensity of immunosuppression in patients who are immunocompromised.

Complications

  • Lung abscesses can occur days to weeks after Klebsiella infection. A lung abscess in a patient with a non–community-acquired pneumonia strongly suggests K pneumoniae infection.
  • Pulmonary gangrene leading to necrosis involves rapid destruction of part of the lung. This is believed to follow vascular compromise. Fortunately, this is rare.
  • Other pulmonary complications include cavitation, empyema, bronchopulmonary fistula, and pleural adhesions.
  • Superinfections can occur while patients are treated for K pneumoniae infection; likewise, K pneumoniae infection can be a superinfection that develops during inpatient treatment for another type of pneumonia.
  • Sepsis can complicate bacteremia and can result in shock and disseminated intravascular coagulopathy.

Prognosis

  • K pneumoniae pneumonia has a 50% mortality rate, even with adequate therapy. The prognosis is worse in patients with alcoholism and bacteremia. Preventive strategies and early diagnosis/treatment help to reduce morbidity.

Miscellaneous

Medicolegal Pitfalls

  • Distinguishing between nosocomial colonization and infection helps limit iatrogenic complications, especially those related to unneeded antibiotics. These include development of resistance, superinfection with resistant organisms, phlebitis, and unnecessary hospital stays.
  • Failure to follow recommended isolation procedures is another pitfall. Strict adherence is required to prevent the spread of antimicrobial-resistant nosocomial pathogens.
 


More on Klebsiella Infections

Overview: Klebsiella Infections
Differential Diagnoses & Workup: Klebsiella Infections
Treatment & Medication: Klebsiella Infections
Follow-up: Klebsiella Infections
Multimedia: Klebsiella Infections
References
Further Reading
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Further Reading

Clinical guidelines

2006 national guideline for the management of lymphogranuloma venereum.
British Association for Sexual Health and HIV - Medical Specialty Society. 1999 Aug (revised 2006 May). 14 pages. NGC:006016

Best practice policy statement on urological surgery antimicrobial prophylaxis.
American Urological Association Education and Research, Inc. - Medical Specialty Society. 2007 Jan. 46 pages. NGC:006297

Management of multidrug-resistant organisms in healthcare settings, 2006.
Centers for Disease Control and Prevention - Federal Government Agency [U.S.]. 2006. 74 pages. NGC:005592

Clinical trials

Risk Factors for Quinolone Resistance Among ESBL Producing Klebsiella Species

Community - Associated Extended-Spectrum Beta-Lactamases (ESBL)

Efficacy and Safety of Colistin for Therapy of Infections Caused by ESBL Producing K.Pneumoniae or E.Coli

Related eMedicine topics

Rhinoscleroma

Urinary Tract Infection, Females

Proteus Infections

Pregnancy, Postpartum Infections

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Keywords

Klebsiella pneumoniae, K pneumoniae, Klebsiella ozaenae, K ozaenae, Klebsiella rhinoscleromatis, K rhinoscleromatis, Klebsiella oxytoca, K oxytoca, Klebsiella planticola, K planticola, Klebsiella terrigena, K terrigena Klebsiella ornithinolytica, K ornithinolytica, community-acquired pneumonia, CAP, nosocomial infection, urinary tract infection, rhinoscleroma, ozena, colonization, extended-spectrum beta-lactamase, ESBL, neonatal septicemia, neonatal bacteremia, bronchopneumonia, bronchitis, catheter-associated bacteriuria, lung infection

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Contributor Information and Disclosures

Author

Obiamiwe Umeh, MBBS, Fellow, Center for AIDS Research and Education, David Geffen School of Medicine at UCLA
Obiamiwe Umeh, MBBS is a member of the following medical societies: American College of Physicians and American Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Leonard B Berkowitz, MD, Chief, Divisions of Infectious Diseases and HIV/AIDS Services, Brooklyn Hospital Center; Clinical Assistant Professor, Department of Medicine, State University of New York at Brooklyn
Leonard B Berkowitz, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, Infectious Diseases Society of America, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Medical Editor

David Hall Shepp, MD, Program Director, Fellowship in Infectious Diseases, Department of Medicine, North Shore University Hospital; Associate Professor, New York University School of Medicine
David Hall Shepp, MD is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Gilead Sciences Salary Management position

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

John W King, MD, Professor of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center; Director, Viral Therapeutics Clinics for Hepatitis; Consulting Staff, Department of Infectious Diseases, Overton Brook Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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