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Nosocomial Pneumonia in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
Necrotizing pneumonia with rapid cavitation (within 72 hours) is the hallmark of Pseudomonas aeruginosa NP/VAP. The NP/VAP with necrosis implies a rapidly invasive destructive process in the lung parenchyma. Aside from rapid cavitation on CXR, an indirect indicator to confirm the diagnosis of a necrotizing pneumonia is by demonstrating elastin fibers in respiratory tract secretions, stained by potassium hydroxide. Elastin fibers are from necrotic lung tissue and are diagnostic of necrotizing pneumonia [1,2]. Multiple cavitary lesions become apparent on CXR <72 hours, and VAP patients with bona fide S. aureus (CAP) or P. aeruginosa (NP/VAP) pneumonia have elastin fibers in the respiratory secretions [6]. Klebsiella pneumoniae also causes a slower and less intense necrotizing pneumonia. The cavitation with necrotizing K. pneumoniae pneumonia occurs after 3–5 days rather than in <72 hours [21,22]. The differences in cavitation rates are a diagnostic clue to the etiology of the necrotizing pathogen, i.e., K. pneumoniae versus P. aeruginosa or S. aureus [2].
Bacteria
Published in Loretta A. Cormier, Pauline E. Jolly, The Primate Zoonoses, 2017
Loretta A. Cormier, Pauline E. Jolly
Klebsiella pneumonia is considered an emerging zoonotic infection that can be transmitted through food, water, or soil contaminated with wild or domesticated animal feces. Most commonly, K. pneumonia occurs as an opportunistic infection that affects immunocompromised hosts. Klebsiella spp. are widely distributed in the environment and found in water, sewage, and soil and can also contaminate inanimate objects (Podschun and Ullman 1998). Klebsiella spp. can be found in the nasopharynx and intestinal tracts of humans, many nonhuman primates, and other wild and domesticated animals, where it is usually asymptomatic (Singh and Sharma 1999). As an emerging infection, it is of most concern due to the role of K. pneumonia (and to a lesser extent, K. oxytoca) as an antibiotic resistant nosocomial infection in hospital patients, causing both pneumonia and abscesses (Podschun and Ullman 1998; Singh and Sharma 1999). In patients who undergo antibiotic treatment, K. pneumonia can be an opportunistic colonizer; among those with the infection, antibiotic resistant strains can be difficult to treat. It is also a problem in neonatal units with the immunologically immature.
Practice Paper 9: Answers
Published in Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar, Get ahead! Medicine, 2016
Anthony B. Starr, Hiruni Jayasena, David Capewell
Klebsiella pneumoniae causes a marked systemic disturbance and is a recognized cause of hospital-acquired infections and aspiration pneumonia. Patients are very unwell with a cough productive of purulent dark sputum. Chest X-ray can show widespread consolidation, often in the upper lobes.
New advances in management and treatment of multidrug-resistant Klebsiella pneumoniae
Published in Expert Review of Anti-infective Therapy, 2023
Alessandro Russo, Paolo Fusco, Helen Linda Morrone, Enrico Maria Trecarichi, Carlo Torti
Klebsiella pneumoniae has a well-known tendency to spread clonally within healthcare institutions and exhibits a particular ability to cause nosocomial outbreaks. The principal vehicle of nosocomial spread of K. pneumoniae strains is through health-care workers’ hands. Indeed, there is extensive evidence concerning transmission via the hands of health-care-workers from colonized patients or environmental reservoirs to new patients, in both epidemic (in case of an outbreak) and endemic (considering it as situations/settings where there are constant challenges about management from admissions of colonized or infected patients with MDR-GNB) situations [38]. Particularly a study showed that 17% of ICU staff carried Klebsiella spp. on their hands and that these strains were probably related to colonized or infected inpatients; the study also highlighted that an epidemic MDR-Klebsiella spp. survived on fingertips better than susceptible strains and persisted longer than E. coli and P. aeruginosa [39]. This transfer of viable amounts of Klebsiella spp. to health-care workers’ (HCWs’) hands took place following simple ‘clean’ procedures, such as caring for patients’ hygiene and touching parts of the body during nursing activities (i.e. taking blood pressure, pulse and oral temperature) [38,40].
In vitro and in vivo activity of meropenem+avibactam against MBL-producing carbapenem-resistant Klebsiella pneumoniae
Published in Expert Review of Anti-infective Therapy, 2023
Xiuyun Li, Zhaowen Chen, Jin Jiao, Shifu Wang, Yuehua Wang, Weiwei Wu, Huijun Yang, Hongxiang Lou
The emergence of bacterial resistance threatens the clinical usefulness of antibiotics and creates a serious global public health situation [1,2]. Klebsiella pneumoniae (K. pneumoniae) is a common cause of antimicrobial-resistant opportunistic infections in hospitalized patients. It is naturally resistant to penicillins, and its members often carry acquired resistance to multiple antimicrobials [3]. Carbapenems are often the drugs of last resort to control multi-drug resistant (MDR) K. pneumoniae infections. In recent years, with the widespread use of carbapenems, carbapenem resistant K. pneumoniae (CRKP) strains have gradually emerged and become widely popular. The production of carbapenemases, mainly K. pneumoniae carbapenemase (KPC) and metallo-β-lactamases (MBLs), is closely related to the resistance of K. pneumoniae to carbapenems [4,5]. CRKP often develops resistance to multiple antibacterial agents at the same time, and treating the infections caused by CRKP poses a huge challenge due to limited treatment options. Hence, CRKP is responsible for significant morbidity, mortality, and excess healthcare costs [4,6]. Thus, CRKP strains are considered to be an urgent public health threat of international concern and has been a research focus, requiring new therapies for these organisms.
Lactobacillus rhamnosus Sepsis Associated with Probiotic Therapy in a Term Infant with Congenital Heart Disease
Published in Fetal and Pediatric Pathology, 2022
Seda Aydoğan, Dilek Dilli, Ahmet Özyazici, Nesibe Aydin, Hüsniye Şimşek, Utku Arman Orun, Ömer Nuri Aksoy
An eight-day-old male patient was admitted to our NICU with a rapid respiratory rate of 74/min (reference range:20-60/min) and respiratory failure. He was born by vaginal delivery at term with a birth weight of 2500 g. CoA and borderline hypoplastic left heart syndrome (HLHS) was detected by echocardiography. He underwent aortic repair and pulmonary banding operation on the postnatal 24th day. During the NICU stay, the patient needed long-term mechanical ventilation (MV) due to cardiorespiratory failure. Recurrent systemic infections (pneumonia and sepsis caused by Klebsiella pneumonia) developed. We began enteral probiotic supplementation to reduce nutritional intolerance and to prevent NEC as he could not be fed sufficiently on the 10th day of surgery. On the 12th day of probiotic therapy, (Lactobacillus rhamnosus GG 1 × 109 colony-forming unit (CFU), Maflor®), the patient developed fever and nutritional intolerance. Laboratory results included a C- reactive protein of 47.8 mg/L (reference range: <1mg/L), white blood cell count of 13,050 cells/mL (reference range: 5,000-15,000), neutrophil count of 9,220 cells/mL (reference range:1,800-5,400), and a platelet count of 102,000 cells/mL (reference range:15,0000-400,000). During this period, the patient was under treatment with colistin, liposomal amphotericin B and meropenem based on the culture results and NICU flora. Lactobacillus rhamnosus grew in blood culture.