Overview
Klebsiella pneumoniae is a Gram-negative, capsulated rod that is found in the normal gut flora and can cause infections including pneumonia (usually after aspiration) and urinary tract infections. Klebsiella pneumonia tends to affect the upper lobes.
Klebsiella infection is rare in immunocompetent people and it tends to cause nosocomial and opportunistic infections in susceptible people, such as those with diabetes mellitus, chronic alcohol excess, and COPD.
Risk Factors
Key risk factors are:
- Diabetes mellitus
- Chronic alcohol excess
- Aspiration
- Institutionalisation/prolonged hospitalisation
Presentation
A Klebsiella pulmonary infection may present with:
- Pneumonia features – productive cough, fever, dyspnoea, nausea
- Risk factors – aspiration, chronic alcohol excess, diabetes mellitus
- ‘Red-currant jelly sputum’ – due to significant inflammation and necrosis of infected tissue
- Upper lobe auscultation findings – crackles, bronchial breathing, dullness to percussion
Investigations
Overview
Key investigations are:
- Sputum/blood culture:
- Identifies Klebsiella
- Chest X-ray:
- May show multiple cavitating opacities, often in the upper lobes
Management
Its management may involve the use of cefuroxime and IV metronidazole.
Complications
Key complications are lung abscesses and/or empyema formation.
Prognosis
- The prognosis is poor, with mortality rates higher than 50% in people with the risk factors mentioned above or sepsis
