The AMR Narrative

Carbapenem-resistant Klebsiella pneumoniae (CR-Kpn)

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What is carbapenem-resistant Klebsiella pneumoniae (CR-Kpn)?

Carbapenem-resistant Klebsiella pneumoniae (CR-Kpn) is a type of Klebsiella pneumoniae resistant to carbapenems, a type of last-line antibiotics used to treat serious multidrug-resistant bacterial infections.

Klebsiella pneumoniae has the ability to develop resistance through diverse mechanisms. CR-Kpn bacteria can produce substances (called carbapenemases) that break down carbapenems and other so-called beta-lactams antibiotics (such as penicillin), making these medications ineffective. Unfortunately, some CR-Kpn bacteria are even resistant to all available antibiotics, causing infections very difficult to treat.

Moreover, CR-Kpn can share its genetic code with other bacteria, rapidly spreading resistance. That is why it is considered a serious public health threat. As species included among the carbapenem-resistant Enterobacterales (CRE), CR-Kpn has been listed among the top priority bacterial pathogens to guide discovery, research and development of new antibiotics by the World Health Organization (WHO).

What is Klebsiella pneumoniae?

To understand CR-Kpn, it is important to know what Klebsiella pneumoniae is.

Klebsiella pneumoniae is a bacterium (bacteria), gram-negative, and rod-shaped. It belongs to the big order of the Enterobacterales, together with other species of bacteria, such as Escherichia coli. When Enterobacterales develop resistance to carbapenems, they are called carbapenem-resistant Enterobacterales (CRE), which include carbapenem-resistant Klebsiella pneumoniae (CR-Kpn), as well.

Klebsiella pneumoniae can cause different types of infection, including urinary tract infections, bloodstream infections, pneumonia, skin infections, and meningitis. Life-threatening conditions primarily occur in healthcare settings, such as hospitals and nursing homes, and affect people at high risk, such as those ones with a weakened immune system (see Who is at risk of a Klebsiella pneumoniae infection).

Where can Klebsiella pneumoniae be found?

Klebsiella pneumoniae are normally found in the large intestine, and in human stool (feces). Therefore, bacteria can colonize the gastrointestinal tract, living in a patient without causing symptoms or signs of infections.

However, when the bacteria enter the body, colonization can lead to infection especially in certain groups of people who are at greater risk than others.

How can Klebsiella pneumoniae spread?

Klebsiella pneumoniae bacteria can spread from person to person by skin contact with infected or colonized people (for example, through healthcare workers’ contaminated hands), or contaminated medical equipment or environmental surfaces.
Klebsiella pneumoniae infections are commonly acquired in healthcare facilities. Indeed, medical tools (such as urinary or intravenous catheters, or breathing tubes), and conditions (such as wounds caused by injury or surgery) may allow Klebsiella pneumoniae to enter the patient’s body and cause an infection.


Which infections can Klebsiella pneumoniae cause?

Healthy people usually do not get Klebsiella pneumoniae infections. However, these bacteria can cause life-threatening infections in people considered at risk.

These infections may include:

• Urinary tract infections, usually occurring in patients hospitalised with urinary catheters. Any part of urinary system can be infected, including kidneys (pyelonephritis), bladder (cystitis), and prostate (prostatitis).
• Bloodstream infection. When Klebsiella pneumoniae overcome the defence lines of the body, it can travel inside the bloodstream, causing bacteremia. It can turn into sepsis, an extreme and overactive response of the body to an infection, a life-threatening emergency which requires immediate treatment.
• Pneumonia. The infection of the lungs typically occurs in critically ill patients who require mechanical ventilation.
• Wound and surgical site infections. Klebsiella pneumoniae bacteria can infect skin, and even the tissues immediately beneath the skin. These conditions are more common in people with severe burns, and wounds due to surgery.
• Meningitis. In this life-threatening disease, bacteria can infect the meninges (the membranes covering the brain and spinal cord).

Who is at risk of a Klebsiella pneumoniae infection?

Anyone can develop a Klebsiella pneumoniae infection, but certain groups of people are at greater risk than others, including people:

• with chronic illnesses, such as cancer, diabetes, kidney, lung or liver diseases;
• with a weakened immune system, such as from HIV, immunosuppressants (medications which slow or stop the response of the immune system), or cancer chemotherapy;
• with urinary or intravenous catheters;
• with breathing tubes;
• with severe burns;
• with wounds due to injurie or surgical interventions;
• who are in healthcare facilities, such as hospitals;
• who received certain antibiotics for long periods of time.



How are Klebsiella pneumoniae infections diagnosed?

To correctly diagnose an infection caused by Klebsiella pneumoniae, first of all your physician will perform a physical examination and ask you about symptoms and risk factors. Guided by these elements, your doctor will be able to choose the most appropriate diagnostic tests.

Laboratory tests can identify Klebsiella pneumoniae using a sample taken from an area of the patient’s body likely to contain the microbe (for example, blood, urine, or other tissue or fluid). These samples are sent to a laboratory to grow the microorganism over time using a media on a petri dish (culture) and identify it.

Then susceptibility tests can be carried out to determine which antibiotics are most effective against it, to start the most appropriate antibiotic therapy. Understanding which antibiotic will work best is especially key to carbapenem-resistant Klebsiella pneumoniae (CR-Kpn) as this type of resistant Klebsiella pneumoniae bacteria may only respond to certain medicines. In some cases, they may respond to none.

Novel molecular DNA tests can not only rapidly detect the bacteria directly in a specimen but at same time provide antibiotic resistance results, making it much easier for the physician to choose appropriate antibiotics.

Finally, depending on the type of infection, your physician may recommend additional diagnostics, such as imaging tests.


How are Klebsiella pneumoniae infections treated?

As Klebsiella pneumoniae is a bacterium, therapy is represented by antibiotics. The antibiotic may vary according to the type and severity of the infection, and the results of susceptibility tests. Indeed, some infections, such as those ones caused by carbapenem-resistant Klebsiella pneumoniae (CR-Kpn), are resistant to several antibiotics.

Intravenous antibiotics (medication given through a drip or a tube) are used in case of serious infections, which require to be treated in hospital and need additional therapies, too.

Unfortunately, due to the increasing resistance to the available antibiotics, Klebsiella pneumoniae infections are becoming more and more difficult to treat, and sometimes a combination therapy is needed (this means that two or even three antibiotics may be necessary).


How can Klebsiella pneumoniae infections be prevented?

Following these precautions can lower your risk of getting a Klebsiella pneumoniae infection. Moreover, they help to reduce your chances of spreading bacteria to others, as well.

• Wash your hands thoroughly and regularly with soap and running water. Then dry them with a clean towel, or a disposable paper towel. If you are not able to wash your hands, you can use an alcohol-based hand sanitizer. Keeping your hands clean is particularly important after using the bathroom, before and after handling medical devices or caring for wounds, and before preparing or eating food. Remember: hand hygiene is your best protection against infections.
• Frequently clean surfaces of the home, such as bathrooms, and use disinfecting products to clean especially high-touch surfaces, for example your cell phone, doorknobs, bedside tables, and light switches.
• Wearing gloves if your hands may come in contact with body fluids, stool or bandages from infected wounds. Always wash your hands after removing gloves.



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