For urinary tract infections, urine cultures should become negative. Repeat sputum culture to show clearance of the pathogen is rarely necessary for patients with pneumonia, and chronic colonization is not an indication for continuation of therapy.
Chest x-rays frequently take weeks to resolve completely. In patients with Klebsiella meningitis, a repeat spinal tap after 48 to 72 hours may be helpful to document microbiologic clearance. The duration of therapy after an initial favorable clinical response is generally empiric.
Pneumonia, bacteremia and urinary tract infections require at least 10 days of therapy. Meningitis should be treated for 21 days, and endocarditis for at least 42 days. If fever recurs during therapy, then a superinfection or a drug allergy should be considered. Many of the patients infected with K. Outbreaks of Klebsiella infections, particularly in neonatal intensive care units, have been known for more than 30 years.
Klebsiell a spp. More than 50 studies have been performed in which molecular epidemiologic techniques have been applied to investigation of outbreaks of infection with ESBL producing Klebsiella spp.
In every report, genotypic evidence existed of horizontal transfer of Klebsiella from patient to patient. Outbreaks emanating from a common environmental source have been described but are extremely uncommon. Some outbreaks are monoclonal but in some hospitals a more complicated situation exists in which multiple strains are circulating at any one time. Restriction of third generation cephalosporins or even restriction of cephalosporins as a class has been successfully implemented as a control strategy , I believe that contact isolation precaution measures should accompany changes in antibiotic policy as a mode of control of spread of ESBL producing Klebsiella.
Such an approach requires the identification of asymptomatic carriers of the organism and then accommodation of such individuals in single rooms or cohorting with other colonized patients. Asymptomatic carriers of ESBL producing organisms can be easily identified by plating rectal swabs onto selective media as described in the section "Laboratory Diagnosis" above.
Use of contact isolation precautions has been successful in arresting outbreaks of infection and in reducing new infections in areas in which ESBL producing organisms are endemic , As is the case with acute-care hospitals, patient to patient spread of ESBL producing organisms is a frequent occurrence in nursing homes. Nursing homes may also serve as a reservoir of infection for the acute-care hospitals to which they send patients Interventions similar to those used in acute-care hospitals would appear warranted in some nursing homes.
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View at: Publisher Site Google Scholar. More related articles. Download other formats More. Related articles. These precautions may include strict adherence to hand hygiene and wearing gowns and gloves when they enter rooms where patients with Klebsiella —related illnesses are housed.
Healthcare facilities also must follow strict cleaning procedures to prevent the spread of Klebsiella. To prevent the spread of infections, patients also should clean their hands very often, including:. Some Klebsiella bacteria have become highly resistant to antibiotics. When bacteria such as Klebsiella pneumoniae produce an enzyme known as a carbapenemase referred to as KPC-producing organisms , then the class of antibiotics called carbapenems will not work to kill the bacteria and treat the infection.
Klebsiella species are examples of Enterobacterales, a normal part of the human gut bacteria, that can become carbapenem-resistant. CRE, which stands for carbapenem-resistant Enterobacterales, are an order of germs that are difficult to treat because they have high levels of resistance to antibiotics.
Unfortunately, carbapenem antibiotics often are the last line of defense against Gram-negative infections that are resistant to other antibiotics. Klebsiella infections that are not drug-resistant can be treated with antibiotics. Infections caused by KPC-producing bacteria can be difficult to treat because fewer antibiotics are effective against them. In such cases, a microbiology laboratory must run tests to determine which antibiotics will treat the infection.
They must follow the treatment regimen prescribed by the healthcare provider. If the healthcare provider prescribes an antibiotic, patients must take it exactly as the healthcare provider instructs. Patients must complete the prescribed course of medication, even if symptoms are gone.
If treatment stops too soon, some bacteria may survive and the patient may become re-infected. Patients must wash their hands as often as possible and follow all other hygiene recommendations.
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