Klebsiella

Snapshot

• A 55-year-old man is brought to the emergency department by police after being found confused in the park. Obtaining a history is difficult. On physical exam, the patient smells of alcohol and has a productive cough of red currant jelly. There are decreased breath sounds in the right lung fields. A chest radiograph is obtained, which demonstrates a lobar consolidation concerning for pneumonia. A sputum culture demonstrates Gram-negative bacilli that are facultative anaerobes and lactose fermenting. They have a mucoid appearance on MacConkey agar.  (Klebsiella pneumonia)

Introduction

• Classification
  • a gram-negative, lactose-fermenting, facultative anaerobic bacilli 
• Microbiology
  • contains an abundant polysaccharide capsule leading to mucoid colonies
• Associated conditions
  • granuloma inguinale
  • community-acquired pneumonia
  • lung abscess
  • aspiration pneumonia
  • urinary tract infection
• invasive liver abscess syndrome

Presentation

• Symptoms/physical exam
  • pneumonia
    • red currant jelly sputum 
      • typically seen in patients with diabetes and alcohol use disorder
  • sexually transmitted infection
    • chronic genital ulcers
  • urinary tract infection
    • dysuria
    • urinary frequency
    • urinary urgency
    • suprapubic pain
  • invasive liver abscess
• right upper quadrant pain

Studies

• Culture
  • obtained from possible sites of infection
• mucoid and pink colonies on MacConkey agar 

Treatment

• Medical
  • third generation cephalosporins, carbapenems, aminoglycosides, and quinolones
    • indication
• these agents have activity against Klebsiella; however, susceptibility testing will dictate which antibiotic is best

Complications

• Sepsis