Klebsiella pneumoniae infection: causes, risks and treatment

Klebsiella pneumoniae belongs to a group of bacteria called Gram-negative bacilli. Many people carry it in the bowel without ever knowing, and in that setting it does no harm. Trouble starts when the organism moves to a part of the body where it does not belong, such as the lungs through a breathing tube, the bladder through a catheter, or the bloodstream through a drip site.

The US Centers for Disease Control and Prevention notes that healthy people usually do not get Klebsiella infections. That is the key point for anyone worried after hearing the name: a positive result on a screening swab, or a mention on a ward, does not mean serious illness is inevitable.

The type of illness depends on where the bacteria settle. Symptoms are therefore those of the underlying infection rather than a single recognisable picture.

• Pneumonia: cough, breathlessness, fever and feeling unwell, often in someone already in hospital or on a ventilator.

• Bloodstream infection: fever, chills, a fast heart rate, confusion and, in the worst cases, sepsis.

• Surgical site or wound infection: redness, warmth, swelling, discharge or increasing pain around a wound.

• Urinary tract infection: burning on passing urine, frequency, and sometimes fever, particularly in people with a catheter.

• Meningitis: a rare but serious complication, with severe headache, stiff neck and drowsiness.

The bacterium needs a way in. Medical devices provide one: ventilators, urinary catheters and intravenous lines all create a path from the skin or bowel into sterile areas of the body. Long courses of antibiotics add to the risk because they remove other bacteria that normally compete with Klebsiella, allowing resistant strains to dominate.

People with weakened immune systems, those recovering from major surgery and those with several long-term conditions are also more vulnerable. Spread between patients is mostly by contact, usually via the hands of staff or visitors or via shared equipment, which is why hand hygiene features so heavily in hospital infection-control programmes.

Infections are treated with antibiotics chosen by the laboratory result. A sample such as blood, urine, sputum or a wound swab is grown, the organism identified, and tested against a panel of antibiotics so that doctors can pick one that works. Serious infections are usually treated in hospital with intravenous antibiotics, and any infected device such as a catheter may be removed or replaced.

The CDC describes growing resistance among Klebsiella bacteria, including resistance to carbapenems, which are often considered last-resort antibiotics. The World Health Organization lists Klebsiella pneumoniae alongside E. coli as leading drug-resistant Gram-negative causes of bloodstream infection, often leading to sepsis and organ failure. Where an organism resists many antibiotics, specialist microbiology and infectious diseases advice shapes the choice of treatment, and options can be narrower and less convenient.

Prevention rests on ordinary infection control applied consistently: cleaning hands before eating, after using the toilet and after touching hospital surfaces, using devices only when they are needed and removing them as early as is safe, and keeping antibiotic use to what is necessary.

• Ask staff or visitors who have not cleaned their hands to do so before touching you or your wounds or lines.

• Tell the team if a catheter or drip site becomes sore, red or leaks.

• Take antibiotics exactly as prescribed and do not keep leftovers for later.

• Ask each day whether a urinary catheter or line is still needed.

Hospitals sometimes screen patients with a rectal swab or stool sample to see whether a resistant organism is being carried. A positive screen means the bacteria are present, usually in the bowel, without causing symptoms. Staff may then use single rooms, gloves and aprons to stop spread to other patients. Carriage generally needs no antibiotic treatment of its own, and the result is recorded so that doctors can choose antibiotics sensibly if you do later develop an infection.

Anyone who has been in hospital and later develops a fever, breathlessness, confusion or a spreading wound problem should seek medical help promptly and mention the previous result.

The NHS advises calling 999 for signs of sepsis such as very fast breathing, confusion, blue or pale skin, a non-blanching rash or feeling much worse very quickly. In babies and young children signs include rapid breathing, seizures, unusual sleepiness and reduced urine. NHS 111 can advise if you are unsure whether symptoms after a hospital stay need same-day review.