KLEBSIELLA, the bacteria reported to have contributed to the deaths of several newborn babies at the University Hospital of the West Indies in the recent dead baby scandal, is a type of Gram-negative bacteria that can cause different types of healthcare-associated infections, including pneumonia, bloodstream infections, wound or surgical site infections, and meningitis. Increasingly, Klebsiella bacteria have developed antimicrobial resistance, most recently to the class of antibiotics known as carbapenems.

Klebsiella bacteria are normally found in the human intestines (where they do not cause disease). They are also found in human stool (faeces). In health-care settings, Klebsiella infections commonly occur among sick patients who are receiving treatment for other conditions. Patients whose care requires devices like ventilators (breathing machines) or intravenous (vein) catheters, and patients who are taking long courses of certain antibiotics are most at risk for Klebsiella infections. Healthy people usually do not get Klebsiella infections.

How Klebsiella bacteria are spread

To get a Klebsiella infection, a person must be exposed to the bacteria. For example, Klebsiella must enter the respiratory (breathing) tract to cause pneumoniae, or the blood to cause a bloodstream infection.

In health-care settings, Klebsiella bacteria can be spread through person-to-person contact (for example, from patient to patient via the contaminated hands of health-care personnel, or other persons) or, less commonly, by contamination of the environment. The bacteria are not spread through the air.

Patients in health-care settings also may be exposed to Klebsiella when they are on ventilators (breathing machines), or have intravenous (vein) catheters or wounds (caused by injury or surgery). Unfortunately, these medical tools and conditions may allow Klebsiella to enter the body and cause infection.

Preventing Klebsiella from spreading

To prevent spreading Klebsiella infections between patients, health-care personnel must follow specific infection control precautions. 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. Health-care 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:

* Before preparing or eating food

* Before touching their eyes, nose or mouth

* Before and after changing wound dressings or bandages

* After using the restroom

* After blowing their nose, coughing, or sneezing

* After touching hospital surfaces such as bed rails, bedside tables, doorknobs, remote controls, or the phone

Drug-resistant Klebsiella

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 Enterobacteriaceae, a normal part of the human gut bacteria, that can become carbapenem-resistant.

CRE, which stands for carbapenem-resistant Enterobacteriaceae, are a family 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 defence against Gram-negative infections that are resistant to other antibiotics.

Treating Klebsiella infections

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.

What should patients do if they think they have a Klebsiella-related illness?

See a health-care provider.

What should patients do if they have been diagnosed with a Klebsiella-related illness?

They must follow the treatment regimen prescribed by the health-care provider. If the health-care provider prescribes an antibiotic, patients must take it exactly as the health-care 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.

How would someone know if their Klebsiella infection is drug-resistant?

The health-care provider will order laboratory tests to determine if the Klebsiella infection is drug-resistant.

Can a Klebsiella infection spread to the patient’s family members?

If family members are healthy, they are at very low risk of acquiring a Klebsiella infection. It is still necessary to follow all precautions, particularly hand hygiene. Klebsiella bacteria are spread mostly by person-to-person contact and hand hygiene is the best way to prevent the spread of germs.

Information taken from the Centers for Disease Control and Prevention website at www.cdc.gov