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Microbiology Part 1 > Lec13 Klebsiella > Flashcards

Lec13 Klebsiella Flashcards

(47 cards)

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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?

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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?

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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?

Study These Flashcards
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?

Study These Flashcards
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?

Study These Flashcards
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?

Study These Flashcards
A

all are resistant to ampicillin

because have a penicillin-specific B lactamase

25
What are the 3 anti-pseudonomal penicillins?
- piperacillin, ticarcillin, carbenicillin [piperacillin most potent] - often combined with B lactamase inhibitor ex. piperacillin-tazobactam
26
What do anti-pseudonomal penicillins cover?
- gram negative rods including pseudomonas - often compined with B lactamase inhibitor - --- piperacillin- tazobactam
27
What is ampicillin-sulbatcam used to treat?
- ampicillin susceptible enteroccocus - anaerobes - sinusitis, dog and cat and human bites, community acquired lung abscesses, intra-abdominal infections
28
What is piperacillin-taxobactam [or ticarcillin-clavulanate] used to treat?
- pseudomonas - ampicillin-susceptibl enterococcus - anaerobes - healthcare associated infections covers everything of ampicillin sulbactam + better gram negative coverage
29
What is cefazolin used to treat?
- gram positive cocci [MSSA, GBS] | - e coli, k pneumoniae, p mirabilis
30
What is cefepime used to treat? does it cross blood brain barrier? is it susceptible to b lactamases?
- 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
What oganisms have chromosomal inducible B-lactamase?
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
What are two plasmid mediated B lactamases?
ESBL | KPC
33
What is ESBL? What drug do you use with organisms that have ESBL?
- 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
What is clinical use of carbapenems?
- 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
What are the four carbapenems?
imipenem-cilastatin meropenem ertapenem doripenem
36
What is clinical use of imipenem-cilastatin?
- treat ESBL-producing gram negatives | - acinetobacter and pseudomonas
37
What is clinical use of meropenem?
- carbapenem of choice for meningitis | - activity against burkholderia cepacia
38
What is clinical use of doripenem?
- similar to meropenem | - use for meningitis, burkholderia cepacia
39
What is clinical use of ertapenem?
- no activity against pseudomonas or acinetobacter | - minimal activity against enterococcus
40
What do you have imipenem and cilastatin together?
- 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
What are adverse rxns of imipenem-cilastatin?
- seizures | - hypersensitivity
42
What is struct of aztreonam? what kind of activity? can it be used to treat bacteria with ESBLs?
- 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
What is mech by which you get carbapenem resistant K. pneumoniae?
- 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
What are treatment options for resistance to carbapenems?
- polymyxin - gentamicin - tygacil
45
What are polymyxins? what do they treat?
- cation that binds to outer membrane and disrupts integrity | - treats only gram negative [E coli, klebsiella spp, enterobacter spp, pseudomonas aeruginosa, acinetobacter spp]
46
What are shortcomings and adverse effects of polymyxins?
- can't penetrate specific sites [lungs, CSF] - nephrotoxicity - neurotoxicity
47
What can tigecyclin treat?
- 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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