As
you may know, we all have millions of bacteria in our gastrointestinal
tracts, primarily in the colon (or "large" bowel). These bacteria
are important for normal bowel health and function. Klebsiella
is the genus name for one of these bacteria. When Klebsiella
bacteria get outside of the gut, however, serious infection
can occur.
As
a general rule, Klebsiella infections tend to occur in people
with a weakened immune system. Many of these infections
are obtained when a person is in the hospital for some other
reason. The most common infection caused by Klebsiella bacteria
outside the hospital is pneumonia.
Klebsiella
pneumonia tends to affect people with underlying diseases, such
as alcoholism, diabetes and chronic lung disease. Classically,
Klebsiella pneumonia causes a severe, rapid-onset illness that
often causes areas of destruction in the lung.
Infected
persons generally get high fever, chills, flu-like symptoms
and a cough productive of a lot of mucous. The mucous (or sputum)
that is coughed up is often thick and blood tinged and has been
referred to as "currant jelly" sputum due to its appearance.
Mortality
in Klebsiella pneumonia is fairly high due to the underlying
disease that tends to be present in affected persons. While
normal pneumonia frequently resolves without complication, Klebsiella
pneumonia more frequently causes lung destruction and pockets
of pus in the lung (known as abscesses).
There
may also be pus surrounding the lung (known as empyema), which
can be very irritating to the delicate lung tissue and can cause
scar tissue to form. At times, surgery may be needed to "rescue"
a lung that is trapped in irregular pockets of pus and scar
tissue.
Klebsiella
can also cause less serious respiratory infections, such as
bronchitis, which is usually a hospital-acquired infection.
Other common hospital-acquired infections caused by Klebsiella
are urinary tract infections, surgical wound infections and
infection of the blood (known as bacteremia). All of these infections
can progress to shock and death if not treated early in an aggressive
fashion.
Many
hospital-acquired infections occur because of the invasive treatments
that are often needed in hospitalized patients. For example,
intravenous catheters used for fluid administration, catheters
placed in the bladder for urine drainage and breathing tubes
for people on a breathing machine can all increase the susceptibility
to infection.
While
these devices may be needed in certain patients, they allow
bacteria to bypass the natural barriers to infection and get
into a persons body. The result may be an infection if the
persons immune system cannot fight the bacteria. Unfortunately,
the people who need invasive treatments often have weakened
immune systems because of their underlying disease.
Klebsiella
bacteria are generally resistant to many antibiotics, such as
penicillin. Often, two or more powerful antibiotics are used
to help eliminate a Klebsiella infection. Usually, a culture
of the suspected infection site is required before a doctor
can know that Klebsiella is the cause of the infection.
This
may involve getting sputum samples (patients are asked to cough
up phlegm into a jar), blood samples (using a needle to draw
blood from a vein), urine samples or a swab (with a q-tip) of
a surgical wound.
Once
the samples are obtained, they are taken to a laboratory and
put in a special substance which allows bacteria to grow (this
is known as "culturing" the bacteria). If bacteria begin to
grow, the lab can determine which type of bacteria it is.
If
the bacteria are Klebsiella, the lab will need to run special
tests to determine which antibiotics are best to treat the infection
(this is known as sensitivity testing). This is important because
different Klebsiella bacteria are resistant to different antibiotics,
so what works for one Klebsiella infection may not work for
another.
These
culture and sensitivity tests may take two to three days to
complete. A doctor may not wait for the test results to start
antibiotics. Often, a powerful antibiotic or two is started
right away once infection is suspected. The antibiotic can be
switched a few days later if the results of the culture and
sensitivity tests suggest a more appropriate drug to treat the
infection.
Klebsiella
bacteria are a part of normal life and live inside almost all
of us. Although it is something we generally dont like to think
about, we need Klebsiella in our colon to keep us healthy. Unfortunately,
once Klebsiella escapes the gut, it can be one nasty bacteria.
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