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Pathophysiology
The bacteria overcome innate host immunity through several means. They
possess a polysaccharide capsule, which is the main determinant of their
pathogenicity. The capsule is composed of complex acidic polysaccharides.
Its massive layer protects the bacterium from phagocytosis by
polymorphonuclear granulocytes. In addition, the capsule prevents
bacterial death caused by bactericidal serum factors. This is accomplished
mainly by inhibiting the activation or uptake of complement components,
especially C3b. The bacteria also produce multiple adhesins. These may
be fimbrial or nonfimbrial, each with distinct receptor specificity. These help
the microorganism to adhere to host cells, which is critical to the infectious
process.
Klebsiellae are ubiquitous in nature. In humans, they may colonize the skin,
pharynx, or gastrointestinal tract. They may also colonize sterile wounds
and urine. Carriage rates vary with different studies. Klebsiellae may be
regarded as normal flora in many parts of the colon and intestinal tract and
in the biliary tract. Oropharyngeal carriage has been associated with
endotracheal intubation, impaired host defenses, and antimicrobial use.
Infection with Klebsiella organisms occurs in the lungs, where they cause
destructive changes. Necrosis, inflammation, and hemorrhage occur within
lung tissue, sometimes producing a thick, bloody, mucoid sputum described
as currant jelly sputum. The illness typically affects middle-aged and older
men with debilitating diseases such as alcoholism, diabetes, or chronic
bronchopulmonary disease. This patient population is believed to have
impaired respiratory host defenses. The organisms gain access after the
host aspirates colonizing oropharyngeal microbes into the lower respiratory
tract.
In addition to prior antibiotic use, risk factors for infection include the
presence of an indwelling catheter, feeding tube, or central venous
catheter; poor health status; and treatment in an intensive care unit or
nursing home. Acquisition of these species has become a major problem in
most hospitals because of resistance to multiple antibiotics and potential
transfer of plasmids to other organisms.
Frequency
United States
International
Mortality/Morbidity
Age