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Agent

Klebsiella spp. are Gram-negative, nonmotile, usually encapsulated rod-shaped bacteria, belonging to the family Enterobacteriaceae. Members of the Enterobacteriaceae family are generally facultatively anaerobic, and the genus consists of 77 capsular antigens (K antigens), leading to different serogroups. Specifically, KPC Klebsiella produce carbapenemase, which allows the bacteria to be resistant to penicillins, cephalosporins, and other antibiotics.

Disease/Infection

Klebsiella spp. have been identified as important common pathogens for nosocomial pneumonia, septicemia, urinary tract infection, wound infections, intensive care unit (ICU) infections, hepatic infections, and neonatal septicemias. Other strains of Klebsiella can cause ozena, meningitis, cerebral abscesses, and rhinoscleroma.

Pathogenicity

Klebsiella spp. are opportunistic organisms, whose pathogenicity factors include adhesins, siderophores, capsular polysaccharides (CPLs), cell surface lipopolysaccharides (LPSs), and toxins, each of which plays a specific role in the pathogenesis of these species. K. pneumoniae is the most infectious to humans among all Klebsiella spp., and its principal virulence is its polysaccharide capsule, which comes in more than 70 antigenic varieties. Rare complications include lung infection involving necrosis and sloughing of the entire lobe. Studies show that as many as 56% of Klebsiella infections are nosocomial.

  • Special populations at risk
    Hospitalized patients, individuals with diabetes and cancer patients are at highest risk of developing Klebsiella bacteremia.

Biosafety Information

Risk Group/BSL
Risk Group 2
Biosafety Level 2 Practices
Biosafety level 2

Modes of Transmission
Klebsiella spp. can be transmitted through skin contact with environmentally contaminated surfaces and/or objects; examples include Loofah sponges, medical equipment, and blood products. Fecal transmission has also been suggested for some cases of bacteremia caused by Klebsiella spp. K. granulomatis can be transmitted through sexual contact.

Transmission
Skin Exposure (Needlestick, bite, or scratch):Direct skin contact with Klebsiella.
Mucous Membrane Splash to Eye(s), Nose or Mouth:Direct mucous membranes contact with Klebsiella
Inhalation:Direct contact with airborne secretions.
Ingestion:Yes

Host Range/Reservoir
pneumoniae – humans, horses, bovines, raptors, and common in all Australian mammals.
oxytoca – humans, mammals (ringtail possums, gliders, and bats) throughout Australia, and insects.
variicola – humans and plants

Symptoms
K. pneumoniae – upper respiratory infection characterized by fevers, chills, and leukocytosis with red currant jelly-like sputum, rare complications include lung infection involving necrosis and sloughing of the  entire lobe. Additionally K. pneumoniae and K. oxytoca can cause community-acquired meningitis and brain abscesses. Clinical symptoms include: headaches, fever, altered consciousness, seizures, and septic shock. K. pneumoniae can also causes pyogenic liver abscesses with symptoms including fever, right-upper-quadrant pain, nausea, vomiting, diarrhea or abdominal pain, and leukocytosis. Klebsiella spp.is a frequent cause of UTIs.

Incubation Period
The incubation period is not clearly understood.

Viability
Gram-negative bacteria are generally susceptible to a number of disinfectants, including phenolic compounds, hypochlorites (1% sodium hypochlorite), alcohols (70% ethanol), formaldehyde (18.5 g/L; 5% formalin in water), glutaraldehyde, and iodines (0.075 g/L).

Survival Outside Host
Klebsiella spp. grow rapidly on surfaces of potatoes and lettuce with counts exceeding 103 organisms per g of surface. They have been found in Loofah sponges made from vegetable gourds. They also survive well within wood and sawdust. They do not grow well on human skin and generally exists in infected individuals and/or surfaces, and the environment; surface water, sewage, soil, and on plants, where they can survive for extended periods of time.

Information for Lab Workers

Laboratory PPE

PPE includes but no limited to a lab coat, gloves and eye protection when direct skin contact with infected materials or animals is unavoidable.

Containment

BSL-2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures. Procedures that are likely to generate aerosols should be conducted in a biosafety cabinet. Practices may be enhanced based on risk assessment.

In Case of Exposure/Disease

  • For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc…):
    • Medical Campus: call or have a coworker call the Control Center at 4–4144.
    • Charles River Campus: call or have a coworker call campus security at 617-353-2121.
      You will be referred to or transported to the appropriate health care location by the emergency response team.
  • For lab exposures (needle sticks, bite, cut, scratch, splash, etc…) involving animals or infectious agents, or for unexplained symptoms or illness call the ROHP 24/7 hour number (1-617-414-ROHP (7647); or, 4-ROHP (7647) if calling from an on-campus location) to be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.
  • Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
  • Provide the wallet-size agent ID card to the physician.

Vaccination

No vaccine is available

Information for First Responders/Medical Personnel

Public Health Issues

Members of Klebsiella spp. can be transmitted from person-to-person; however, the communicability period is unknown. Approximately one-third of people carry Klebsiellae in their stools. Hospital personnel have been shown to frequently carry Klebsiellae on their hands.

Diagnosis/Surveillance

Monitor for symptoms, other tests include isolating strains of the bacteria or typing different isolates. This is often necessary for investigation of endemic and epidemic nosocomial infections and also for epidemiological investigations from the environment. Klebsiellae can be isolated in culture by growth in media from clinical specimen. Biotyping and serotyping are two common forms of typing methods used.

First Aid/Post Exposure Prophylaxis

Perform one of the following actions:

Skin Exposure (Needlestick or scratch):Immediately go to the sink and thoroughly wash the wound with soap and water for 15 minutes. Decontaminate any exposed skin surfaces with an antiseptic scrub solution.
Mucous Membrane Splash to Eye(s), Nose or Mouth:Exposure should be irrigated vigorously.
Splash Affecting Garments:Remove garments that may have become soiled or contaminated and place them in a double red plastic bag.

Post exposure prophylaxis should be considered.

Treatment

Almost 98% of KPC Klebsiella are resistant to fluoroquinolones, and 50% are resistant to gentamicin and amikacin. Antibiotic selection should be tailored to susceptibility testing results for agents beyond the beta-lactam and carbapenem classes, and should include options such as tigecycline, colistin, and aztreonam.

References

Mandell, Bennett, Dolin, et al. Principles and Practice of Infectious Diseases. Seventh edition. Chapter 218 – Enterobacteriaceae.

Public Health Agency of Canada, Klebsiella Fact Sheet; http://www.phac-aspc.gc.ca/msds-ftss/klebsiella-eng.php

Quale, Spelman, et al. Carbapenemases. 2012 UpToDate, Inc. http://www.uptodate.com/contents/carbapenemases?source=see_link&anchor=H8#H8

Biosafety in Microbiological and Biomedical Laboratories; Deborah E. Wilson, DrPH, CBSP Director Division of Occupational Health and Safety National Institutes of Health Bethesda, Maryland L. Casey Chosewood, M.D. Director Office of Health and Safety Centers for Disease Control and Prevention Atlanta, Georgia; US Government Printing Office, Washington DC. 5th Edition; 2009

Revised: 8/23/2012