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Microbiology Part 1 > Lec13 Klebsiella > Flashcards

Lec13 Klebsiella Flashcards

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1
Q

What diseases does klebsiella pneumoniae cause?

A
  • pneumonia
  • UTI
  • healthcare associated infections
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2
Q

How do you distinguish K oxytoca or e coli from K pneumoniae?

A

K oxytoca and e coli can produce indole from tryptophan [indole test]
= are indole positive
k pneumoniae is indole negative

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3
Q

What are the 4 most common enterobacteriacea?

A
  • escherichia, klebisella, shigella, salmonella, yersinia
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4
Q

What are 5 less common but virulent enterobacteriaceae?

A
  • enterobacter, serratia, proteus, morganella, providencia spp.
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5
Q

What are general micro properties of enterobacteriaceae?

A
  • ferment glucose and other sugars
  • produce catalase
  • oxidase negative
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6
Q

What is the epidemiology of klebsiella pneumoniae?

A
  • main reservoir is humans
  • colonize lower GI tract, skin, female genital tract
  • produce disease when get access to sterile sites
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7
Q

What are common clinical manifestations of k. pneumoniae?

A
  • UTI, intra-abdominal infections, pneumonia

- in hospital see: bacteremia [bloodstream infections, wound infections, healthcare associated device related infections

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8
Q

Who has highest risk of K. pneumoniae?

A
  • can be community acquired
  • more often healthcare associated
  • seen in patents and healthcare workers
  • healthcare associated has higher potential for resistance
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9
Q

How can K. pneumoniae be plated?

A
  • isolated readily on routine media

- use MacConkey media –> klebsiella and E coli both ferment lactose so turn pink

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10
Q

Is klebsiella pneumoniae motile?

A

no – non motile

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11
Q

What is significance of klebsiella pneumoniae having a capsule?

A

basis of serotyping [77 serotypes]

its a virulence factor

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12
Q

What are micro properites of klebsiella pneumoniae?

A
  • non motile
  • encapsulated
  • catalase positive
  • ferment glucose and other sugars [posiitve MacConkey]
  • oxidase negative
  • indole negative
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13
Q

What are the virulence factors of K. pneumoniae?

A
  • mucoid polysaccaride capsule
  • hypermucoviscous isolates –> makes more resistant to complement mediated killing

less important:

  • LPS [acts as endotoxin] [O antigen]
  • siderophores
  • pili
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14
Q

What is string test?

A
  • to look for hypermucoviscous isolates
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15
Q

What is function of type 1 vs type 3 pili?

A

type 1 pili helps mediate adherence to epithelium

type 3 is required for biofilm production

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16
Q

What is mech of action of siderophores?

A
  • siderophores sequester iron

- iron essential for bacterial growth

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17
Q

What are 3 common clinical syndromes of klebsiella pneumoniae?

A
  • pneumonia [community or healthcare acquired]
  • intra-abdominal infection [liver abscesses, peritonitis, cholangitis]
  • urinary tract infections
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18
Q

What is friedlander’s disease?

A
  • pneumonia caused by klebsiella pneumoniae
  • hemorrhagic necrotizing lobar pneumonia
  • get currant jelly sputum, occurs mostly in upper lobes
  • similar to other encapsulated organisms but often very complicated [effusion, empyemas, lung abscesses]
  • assocated with immunocompromised
  • high mortality
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19
Q

What kind of intra-abdominal infections does klebsiella pneumoniae cause?

A
  • spontaneous bacterial peritonitis [ in patients with cirrhosis]
  • appendicitis
  • cholangitis or cholecytisis
  • diverticulitis
  • liver abscesses
  • post op infections
20
Q

What are two types of peritonitis?

A

spontaenous peritonitis

  • occurs in patients with liver disease
  • caused by E. coli, strep, klebsiella pneumoniae

secondary peritonitis

  • inflamation abdominal organs
  • secondary to surgical source or appendicial rupture
  • caused by klebsiella or E coli
21
Q

What are two main causes of UTIs? what are complications of UTI?

A
  • E coli most common, then klebsiella pneumoniae
  • complicated UTI can have
  • – renal abscesses
  • – emphysematous pyelonephritis
  • – catheter associated UTIs
22
Q

What are clinical manifestations of klebsiella pneumoniae other than UTI, intra abdominal infections, and pneumonia?

A
  • central venous catheter associated infections

- skin and skin structure infections [necrotizing fasciitis, diabetic foot ulcers, post op wound infections]

23
Q

What are treatments for klebsiella pneumoniae? 4 main drugs?

A

source control: remove catheter, drain abscesses, debridement

antibiotics: vary in susceptibility profiles
- all K pneumoniae are ampicillin resistant

24
Q

What are K pneumoniae resistant to?

A

all are resistant to ampicillin

because have a penicillin-specific B lactamase

25
Q

What are the 3 anti-pseudonomal penicillins?

A
  • piperacillin, ticarcillin, carbenicillin [piperacillin most potent]
  • often combined with B lactamase inhibitor
    ex. piperacillin-tazobactam
26
Q

What do anti-pseudonomal penicillins cover?

A
  • gram negative rods including pseudomonas
  • often compined with B lactamase inhibitor
  • — piperacillin- tazobactam
27
Q

What is ampicillin-sulbatcam used to treat?

A
  • ampicillin susceptible enteroccocus
  • anaerobes
  • sinusitis, dog and cat and human bites, community acquired lung abscesses, intra-abdominal infections
28
Q

What is piperacillin-taxobactam [or ticarcillin-clavulanate] used to treat?

A
  • pseudomonas
  • ampicillin-susceptibl enterococcus
  • anaerobes
  • healthcare associated infections

covers everything of ampicillin sulbactam + better gram negative coverage

29
Q

What is cefazolin used to treat?

A
  • gram positive cocci [MSSA, GBS]

- e coli, k pneumoniae, p mirabilis

30
Q

What is cefepime used to treat? does it cross blood brain barrier? is it susceptible to b lactamases?

A
  • excellent gram + and - coverage
  • including pseudomonas, MSSA
  • stable against many B lactamases
  • crosses BBB
  • not reliable against anaerobes

used to treat healthcare associated infections

31
Q

What oganisms have chromosomal inducible B-lactamase?

A

organisms have them inherently and they get turned on in presence of antibiotics

SPICE organisms
S: serratia spp
P: pseudomonas aeruginosa
I: indole-positive proteceae [proteus vulgaris, providencia spp, morganella morganii]
C: citrobacter spp
E: enterobacter spp
32
Q

What are two plasmid mediated B lactamases?

A

ESBL

KPC

33
Q

What is ESBL? What drug do you use with organisms that have ESBL?

A
  • extended spectrum B lactamase
  • in E coli and k pneumoniae
  • associated with use of broad spectrum antibiotics
  • — when you use ceftriaxone, piperacillin-tazobactam you get induction of ESBL enzyme production
  • resistant to penicillins, cephalosporins, aztreonam
  • treat with carbapenems
34
Q

What is clinical use of carbapenems?

A
  • broad spectrum activity against aerobic and anaerobic g+ and g-
  • reserved for treatment of serious healthcare associated infections
  • broadest spectrum, can treat bacteria with ESBL
35
Q

What are the four carbapenems?

A

imipenem-cilastatin
meropenem
ertapenem
doripenem

36
Q

What is clinical use of imipenem-cilastatin?

A
  • treat ESBL-producing gram negatives

- acinetobacter and pseudomonas

37
Q

What is clinical use of meropenem?

A
  • carbapenem of choice for meningitis

- activity against burkholderia cepacia

38
Q

What is clinical use of doripenem?

A
  • similar to meropenem

- use for meningitis, burkholderia cepacia

39
Q

What is clinical use of ertapenem?

A
  • no activity against pseudomonas or acinetobacter

- minimal activity against enterococcus

40
Q

What do you have imipenem and cilastatin together?

A
  • imipenem degraded by dihydropeptidase in proximal renal tubule, can accumulate nephrotoxic but inactive metabolite
  • cilastatin is dihydropeptidase inhibitor, administered with imipenem to avoid this side effect
41
Q

What are adverse rxns of imipenem-cilastatin?

A
  • seizures

- hypersensitivity

42
Q

What is struct of aztreonam? what kind of activity? can it be used to treat bacteria with ESBLs?

A
  • monobactam that lacks thizolidine ring
  • only active against gram neg + pseudomonal [not g+ or anaerobes]
  • hydrolyzed by ESBLs
  • used for patients with severe penicillin/B-lactam allergy
43
Q

What is mech by which you get carbapenem resistant K. pneumoniae?

A
  • KPC [K pneumoniae carbapenamase] = plasmid mediated B lactamase that hydrolyzes all B lactams including carbapenems
    less common in US
  • metallo-B-Lactamases [NDM1, IMP, VIM]
  • oxacillinases [OXA-48]
44
Q

What are treatment options for resistance to carbapenems?

A
  • polymyxin
  • gentamicin
  • tygacil
45
Q

What are polymyxins? what do they treat?

A
  • cation that binds to outer membrane and disrupts integrity

- treats only gram negative [E coli, klebsiella spp, enterobacter spp, pseudomonas aeruginosa, acinetobacter spp]

46
Q

What are shortcomings and adverse effects of polymyxins?

A
  • can’t penetrate specific sites [lungs, CSF]
  • nephrotoxicity
  • neurotoxicity
47
Q

What can tigecyclin treat?

A
  • skin infections, pneumonia, abdominal infections
  • gram negative bacilli [including ESBL producing enterobacteriaceae]
  • no activity against proteus, pseudomonas, providencia
  • not recommended for bloodstream infections

Microbiology Part 1 (24 decks)

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