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Thread: Klebsiella

  1. #1
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    Klebsiella

    I have had many UTIs over the years. Took years to eradicate a very resistant Pseudomonas infection, but seemed to finally get rid of it. Now I have Klebsiella, which I have never had previously. Good news is it sensitive to almost everything. Just wondering if anyone knows where this could be coming from. Urologist just gave me Cipro twice a day for 10 days. Did same treatment about two months ago, and obviously got it back.

    Thanks
    Shamrock

  2. #2
    Here is a little info on Klebsiella.
    Klebsiella pneumoniae (Today, 7 species with demonstrated similarities in DNA homology are known. These are (1) Klebsiella pneumoniae, (2) Klebsiella ozaenae, (3) Klebsiella rhinoscleromatis, (4) Klebsiella oxytoca, (5) Klebsiella planticola, (6) Klebsiella terrigena, and (7) Klebsiella ornithinolytica. K pneumoniae is the most medically important species of the group. K oxytoca and K rhinoscleromatis have also been demonstrated in human clinical specimens) is a gram-negative bacterium that is also known as one of the opportunistic human pathogens. Read this article to know about the Klebsiella genus, its species and its infections.
    Klebsiella Pneumoniae
    Klebsiella is a gram-negative, rod shaped and non-motile bacteria of the family Enterobacteriaceae. Enterobacteriaceae represents bacteria that normally inhabit the intestines of animals and humans. When they are present outside the gut (alimentary canal between stomach and anus), they cause certain lethal infections in humans. Species of Klebsiella are ubiquitous (present everywhere) and are human-pathogens (disease causing organisms) found in the respiratory, intestinal, and urinogenital tracts. They cause pneumonia (inflammatory illness of the lungs), urinary tract infections (UTI), ankylosing spondylitis (degenerative inflammatory arthritis), septicemia (whole body inflammation) and soft body infections to humans. "Klebsiella" was named after the German pathologist, Edwin Klebs in honor of his work.

    Klebsiella Pneumoniae: General Characteristics
    Klebsiella pneumoniae (K. pneumoniae) is one of the known species of Klebsiella genus. It is one of the most commonly occurring gram-negative bacteria studied worldwide. K. pneumoniae is an encapsulated (presence of a polysaccharide layer outside the cell-wall) bacterium. It is a facultative anaerobic, meaning that it has a characteristic feature of becoming both aerobic (survive in presence of oxygen) and anaerobic (survive in absence of oxygen) depending upon the situation. It can synthesize ATP (adenosine triphosphate) by aerobic respiration, but can also switch on to anaerobic fermentation for deriving energy. It is found naturally in the soil, water and vegetables. Some of the strains of K. pneumoniae are diazotrophs and have an ability to fix atmospheric nitrogen in a more usable form for plants. In humans, it can be found in the skin, pharynx and gastrointestinal tract. However, under certain conditions, it causes serious infections.

    Klebsiella Pneumoniae: Infections
    Klebsiella pneumoniae, the name itself suggests that it is a strain of Klebsiella that causes pneumonia in humans. It can also cause UTI and abdominal infections. In fact, it is the second pathogen, next to E. coli that causes UTI. It normally affects persons with low immune system such as hospital patients, diabetes patients and people with chronic lung disease. Many a times, alcoholics also suffer from K. pneumoniae infections. Thus, the infections are either hospital-acquired or community-acquired.

    It is difficult for K. pneumoniae to infect lungs of healthy persons. However, it produces a highly lethal pneumonia in those people who have been hospitalized, typically after two days of hospitalization and is therefore commonly known as hospital-acquired pneumonia. It causes a serious, rapid-onset illness that can result in destruction of the lungs. The most common symptom of this type of pneumonia is cough with sputum secretion. The patient may also suffer from chills, chest pain, high fever, shortness of breath and flu-like symptoms. In severe cases, it may cause lung destruction and formation of lung abscesses (pockets of pus). Pus may also be present in tissues surrounding the lung known as empyema, which can lead to formation of scar tissue. Mortality rate of this pneumonia is more than regular pneumonia due to the underlying diseases of the affected persons.

    Klebsiella Pneumoniae: Infections - Diagnosis and Treatment
    Diagnosis of klebsiella pneumonia is done on the basis of patient’s symptoms, physical examination with further investigations like chest X-ray, blood test and sputum cultures.

    Klebsiella pneumonia is difficult to treat and repetitive occurrence of the disease is seen, which the patient continues to suffer for a longer duration. Treatment for klebsiella pneumonia is usually done by using antibiotics such as aminoglycosides, bactericidals such as cephalosporins and other prescribed medications. Treatment depends upon the patient’s health condition, medical history and severity of the infectious disease. It is always recommended to take precautions in order to prevent from such infections.

    By Ningthoujam Sandhyarani
    http://www.buzzle.com/articles/klebs...neumoniae.html


    I have had Klebsiella pneumoniae and K.oxytoca urinary tract infections and they have been treated at various times with Septra, Macrodantin, or Cipro. My urologist tries to use the "big gun" Cipro as a last resort.

    What is your method of bladder management? Have you thought of trying Microcyn/Vetericyn as a method of keeping infection free? You may want to read your way through this thread to get more insight and information about it. http://sci.rutgers.edu/forum/showthread.php?t=133414

    All the best,
    GJ

  3. #3
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    Thank you for your input greatly appreciated. I am a c4 quadriplegic, injured 25 years. I have a sphincterotomy, so I drain continuously. UTI has always been an issue. As I said previously a resistant Pseudomonas infection has been very troublesome over the last three or four years. I was able to clear this using vetericyn 50 ML and leaving it in my bladder for approximately one hour. Strange thing is I have continued this as a prophylactic measure to avoid UTI, and still have developed the Klebsiella infection over the last month or so. My urologist prescribed, and I just started Cipro 500 mg b.i.d.

    thanks again
    Shamrock

  4. #4
    I suspect you are using a condom catheter attached to a leg bag and a night drain bag. First, even with the sphincterotomy, your bladder may not be draining completely, allowing for some urine to remain in the bladder all the time and becoming the incubator for infection. Secondly, the urine bags must be kept extremely clean and changed out at least once a month. I have a supra pubic and was using vetericyn, but I was not cleaning my leg bag because I thought I was using a closed system procedure for the drainage bags. I would clear up an infection with antibiotics and then use vetericyn, but after a couple weeks I would become colonized and/or come up with another infection (same one or different one). Then I started to clean and rinse the leg bag and tubing twice a day with alcohol and cleaning the rigid night drain bottle (I don't use the typical night drain bag) and tubing with bleach. I have continued this process and am instilling 20cc of Vetericyn and 10cc of sterile saline into the bladder and holding it there for about 20-25 minutes once a day. The only thing that has changed is the way and frequency of cleaning the urine storage devices. You may also be experiencing some bacterial reinfection from the condom catheter or pooling of urine in the condom catheter that is introducing infection into the urethra.
    Just a few thoughts.

    All the best,
    GJ

  5. #5
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    I don't know if you have recently been in a hospital or not, but here is an abstract of klebsiela and tetraplegic patients

    View This Abstract Online
    [Prevalance of nosocomial infections in tetraplegic upper extremity surgery. Prospective study of twenty patients]
    Ann Chir Plast Esthet. 2002; 47(1):12-6 (ISSN: 0294-1260)

    Kron C; Revol M; Felten A; Marie O; Cormerais A; Laffont I; Servant JM
    Service de chirurgie plastique et reconstructrice, hôpital Saint-Louis, 1, avenue Claude Vellefaux, 75475 Paris, France. cedric.kron@waika9.com

    INTRODUCTION: Many risk factors of nosocomial infection may be met with tetraplegic patients. The objective of this work was to study the prevalence of colonization by 3 multiresistants bacteria (methicillin resistant staphylococcus aureus (MRSA), Klebsiella pneumoniae with widened spectrum beta lactamase or multi-resistant Acinetobacter baumannii) on this population. MATERIAL AND METHODS: It was about a prospective study for which we included 20 consecutive patients coming from a rehabilitation of long stay center to have a surgical operation of palliative reanimation of the upper limb. For each patient, the first morning of his hospitalization, many sites cultures were carried out for bacteriological analysis whose results were returned in 48 h to the operator. No patient was excluded. RESULTS: Five patients (25%) showed the presence of SARM. One patient (5%) showed the presence of Klebsiela pneumoniae. One of the patients carrying a SARM was also carrying Acinetobacter baumannii. Overall 6 patients were contaminated (30%) but no postoperative infection occurred, neither at the time of the hospitalization nor after the exit of the service. DISCUSSION: The various risk factors of nosocomial infection appearance met in tetraplegic patient were analyzed. This study showed that the cares of tetraplegic patients limited to the maximum the risk of nosocomial infection appearance (no one in this series) in spite of an important contamination met in this type of population which presents long durations of hospitalization, main risk factor regularly met.

  6. #6
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    gj-you are right on, I do use an external catheter, which is change daily. Because of these infections I am scrupulous nearly neurotic about cleaning and trying to keep germ-free. I use a overnight drainage bag when in bed, and a urocare leg bag with a quick drain valve used for emptying, went up in my wheelchair. The bag that I am not using is always filled with 50% bleach/50% tapwater. I change overnight bag every two weeks. The leg bag I generally use quite a bit longer because they are very expensive. Even though it is always stored with a strong bleach solution may be a need to change these more frequently. Thanks again for your input.
    Shamrock

    Elaine-very interesting study, luckily I haven't been in the hospital in over five years. Thanks for your input

  7. #7
    Quote Originally Posted by shamrock88 View Post
    gj-you are right on, I do use an external catheter, which is change daily. Because of these infections I am scrupulous nearly neurotic about cleaning and trying to keep germ-free. I use a overnight drainage bag when in bed, and a urocare leg bag with a quick drain valve used for emptying, went up in my wheelchair. The bag that I am not using is always filled with 50% bleach/50% tapwater. I change overnight bag every two weeks. The leg bag I generally use quite a bit longer because they are very expensive. Even though it is always stored with a strong bleach solution may be a need to change these more frequently. Thanks again for your input.
    Shamrock
    Elaine-very interesting study, luckily I haven't been in the hospital in over five years. Thanks for your input
    Do you use the Urocare Vinyl leg bags or the Latex leg bags?
    http://www.urocare.com/products/Uro-...aryLegBags.php
    http://www.urocare.com/products/Uroc...aryLegBags.php
    I don't think the vinyl or latex bags hold up well or are cleaned thoroughly with bleach. Urocare recommends their acid based cleaner, Urolux for the latex bags. I use the Urocare Vinyl leg bags and clean them with 70% alcohol. First rinse with hot water, drain, add 1/4 cup alcohol, connect tube to drain valve and slosh, then rinse with hot water, dry and use. I use the rigid plastic Urocare drain bottle (http://www.urocare.com/products/Urin...nageBottle.php) that I clean with bleach.

    All the best,
    GJ

  8. #8
    There are certainly different ways to clean the bags and they most certainly can be contributing to the problem. However, I am more inclined to believe that the culprit is the external catheter. The bugs can crawl right back up the urethra.

    Make sure that you are drinking enough and that you keep everything as clean as possible. It sounds as though you already do that.

    CKF

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