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MICROBIOLOGY LEGEND

CYCLE 38 ORGANISM 2

Klebsiella pneumoniae
Klebsiella pneumoniae is a Gram-negative, nonmotile, encapsulated, lactose-fermenting, facultative anaerobic,
rod-shaped bacterium. K. pneumoniae is able to grow either with or without free oxygen, deeming it a facultative
anaerobe. This organism is also surrounded by a capsule, which increases its virulence by acting as a physical
barrier to evade the host’s immune response. Members of the Klebsiella genus typically express two types of
antigens on their cell surfaces. The first, O antigen, is a component of the lipopolysaccharide (LPS), of which 9
varieties exist. The second is K antigen, a capsular polysaccharide with more than 80 varieties. Both contribute to
pathogenicity and form the basis for serogrouping.

K. pneumoniae is found in the normal flora of the mouth, skin, and intestinal tract of humans where it initially
does not cause disease. K. pneumoniae can progress into severe bacterial infections leading to pneumonia,
bloodstream infections, wound infections, urinary tract infections, and meningitis. Patients who require
equipment such as catheters or ventilators are at high risk for infections. Also, a patient administered a course of
broad-spectrum antibiotic treatment is at a high risk due to the disruption of the normal flora, deeming them
more susceptible to pathogens.

The genus Klebsiella was named after the German bacteriologist Edwin Klebs (1834–1913). Also known as
Friedlander's Bacillum in honor of Carl Friedlander, a German pathologist, who proposed that this bacteriae was
the etiological factor for the pneumonia seen specially in immunocompromised individuals such as sufferers of
chronic diseases or alcoholics. Danish scientist Hans Christian Gram (1853–1938) developed the technique now
known as Gram staining in 1884 to discriminate between K. pneumoniae and Streptococcus pneumoniae.

Clinical significance
K. pneumoniae can cause destructive changes to human lungs via inflammation and hemorrhage with cell death
(necrosis) that sometimes produces a thick, bloody, mucoid sputum (currant jelly sputum). These bacteria gain
access typically after a person aspirates colonizing oropharyngeal microbes into the lower respiratory tract. As a
general rule, Klebsiella infections are seen mostly in people with a weakened immune system. Most often, illness
affects middle-aged and older men with debilitating diseases. This patient population is believed to have
impaired respiratory host defenses, including persons with diabetes, alcoholism, malignancy, liver disease,
chronic obstructive pulmonary diseases (COPD), glucocorticoid therapy, renal failure, and certain occupational
exposures (such as paper mill workers). Many of these infections are obtained when a person is in the hospital
for some other reason (a nosocomial infection). Faeces are the most significant source of patient infection,
followed by contact with contaminated instruments.

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 P.O. Box 131375, Bryanston, 2074
Ground Floor, Block 5
Bryanston Gate, 170 Curzon Road
Bryanston, Johannesburg, South Africa
www.thistle.co.za
Tel: +27 (011) 463 3260
Fax: +27 (011) 463 3036
Fax to Email: + 27 (0) 86-557-2232
e-mail : service@thistle.co.za
Diagnosis
K. pneumoniae may be isolated from blood, urine, pleural fluid, and wounds. By simply gram staining a sputum
sample obtained from a patient could lead one to diagnosing K. pneumoniae. Cultures should be obtained from
sites such as open wounds, peripheral or central intravenous access sites, urinary catheters, and respiratory
equipment. Chest radiography can also lead the way in diagnosing a K. pneumoniae infection. The organism
usually resides in one of the upper lobes of the lungs, but may also be involved in lower portions as well. The lobe
will appear swollen and can, in many cases, produce abscesses.

Lab Findings
Klebsiellae appear as short, plump, gram-negative bacilli. They are usually surrounded by a capsule that appears
as a clear space. Cultures should be obtained from possible sites (e.g., wounds, peripheral or central intravenous
access sites, urinary catheters, respiratory support equipment). Klebsiellae are microaerophilic and, thus, can
grow in the presence of oxygen or in its absence. They have no special culture requirements. Most species can
use citrate and glucose as sole carbon sources; thus, they grow well on most ordinary media. Klebsiellae are
lactose-fermenting, urease-positive, and indole-negative organisms, although K. oxytoca and some strains of K
pneumoniae are exceptions. Klebsiellae do not produce hydrogen sulfide, and they yield positive results on both
Voges-Proskauer and methyl red tests.

Treatment
Unfortunately, K. pneumoniae is resistant to a number of antibiotics, deeming treatment options very limited.
Choosing an antibiotic treatment for K. pneumoniae depends on the organ system that has been targeted. The
choice is especially modified for people with confirmed bacteremia. Antibiotics with high intrinsic activity against
K. pneumoniae include cephalosporin, carbapenems, aminoglycosides, and quinolones. These treatments are
initially used as monotherapy or even as a combination. For patients who are severely ill, an initial course, usually
between 48-72 hours of combination aminoglycoside therapy, is suggested. This should then be followed by an
extended-spectrum cephalosporin.

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Accredited to ISO 17043
Certificate available on request or at www.sanas.co.za Page 2 of 3
 P.O. Box 131375, Bryanston, 2074
Ground Floor, Block 5
Bryanston Gate, 170 Curzon Road
Bryanston, Johannesburg, South Africa
www.thistle.co.za
Tel: +27 (011) 463 3260
Fax: +27 (011) 463 3036
Fax to Email: + 27 (0) 86-557-2232
e-mail : service@thistle.co.za

Prevention
To prevent the spread of infections, patients should remain very cautious of their hand washing habits. Hand
washing with soap and water should happen in the following instances: before touching eyes, nose, or mouth,
before preparing food, before addressing bandaged or wound areas and after using the restroom. It is especially
important to be cautious when entering and exiting hospital rooms. Proper hand washing techniques should be
used after touching doorknobs, bed rails, using hospital restroom, and interacting with sick patients.

References
1. http://microbewiki.kenyon.edu/index.php/Klebsiella_pneumoniae_pathogenesis
2. http://en.wikipedia.org/wiki/Klebsiella_pneumoniae

Questions
1. How would you identify a patient with K. pneumonia infection in your lab?
2. Discuss the morphological characteristics of K. pneumonia
3. Discuss the pathophysiology of K. pneumonia.

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