Klebsiella pneumoniae – prevention and treatment

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  • Klebsiella-pneumoniae-–-prevention-and-treatment

Increasingly, some strains of Klebsiella pneumoniae have developed resistance to certain classes of antibiotics such as carbapenems, by acquiring a gene mutation that helps them to produce an enzyme that creates a resistance to the strongest of antibiotics.

Klebsiella pneumoniae (KP) is a type of gram-negative rod-shaped bacteria that can cause different types of infections ranging from pneumonia (lung), blood infections (septicaemia), wound or surgical infections, urinary tract infections, small intestinal bowel overgrowth (SIBO), ankylosing spondylitis, Crohn’s disease, ulcerative colitis and meningitis (brain).

KP belongs to the Enterobacteriaceae family of bacteria, the same family as Salmonella and E. coli. The microbes that are resistant to antibiotics are called carbapenem-resistant Enterobacteriaceae (CRE). Carbapenem-resistant KP is the most common type of CRE, and is responsible for causing the vast majority of gram-negative bacterial infections in community and healthcare settings in Australia.[1]

KP infectionscan be transmitted in healthcare settings by person-to-person contact via contaminated hands, ventilators, intravenous catheters, or wounds where it can cause respiratory and/or blood infections. The bacteria are not airborne, so you can’t contract a KP infection by breathing the same air as an infected person.

KP bacteria are normally found in the human intestinal tract where they do not cause disease in normal circumstances but can also act as a human opportunistic pathogenic infection when it proliferates in increased amounts, where it may cause a host of health complaints and symptoms. When the immune system is healthy, it maintains KP in healthy numbers which can even offer benefit.

KP colonises much of the human body, from our nasal passages and mouth to our digestive tracts, and it is also found in soil and some plants. Different strains of KP, when found in normal healthy amounts, helps us to digest carbohydrates such as lactose, resistant starches, inulin, fructose, and mannose.[2]

KP intestinal infections become problematic when the KP bacteria become opportunistic and increase in numbers to our detriment. This generally occurs in people with compromised immune systems and/or dysbiotic intestinal tracts. Some are labelling KP as the new superbug. This can be attributed to the combination of antibiotic resistant strains, environments with a high number of immunocompromised patients, in particularly hospitals and nursing homes, and people with compromised gut flora due to gut dysbiosis. This multifactorial causation is opening up the flood gates to increases in KP type infections.

Klebsiella infections with varied symptomatology

Pneumonia (lung)
Early signs and symptoms of pneumonia include high fevers, chills, flu-like symptoms, cough with yellow and/or bloody mucus, shortness of breath and chest pain. In the case of pneumonia caused by KP that is antibiotic resistant, the mortality rate may be as high as 50%.[3]

Urinary tract infections (UTIs)
UTIs can be caused from KP contaminated catheters and symptoms may include fever, lower abdominal pain, bloody urine, frequent urination, back pain and vomiting.[3]

Wound and soft tissue infections
Symptoms of KP soft tissue infections may include fever, swelling, skin colour changes and/or sudden redness of the tissue surrounding the wound. These infections can be caused from contaminated surgical instruments, hand contact or anything that may be contaminated with KP that comes into direct contact with the wound.[3]

Ankylosing spondylitis (AS) and Crohn’s disease (CD)
Many studies have confirmed KP is a likely trigger for AS, CD and ulcerative colitis. Genetically susceptible people, such as those who have the HLA-B27 allelotypes and consume a high starch diet, can trigger a growth in KP in the bowel, the starch becoming a main food supply for KP.[4]

KP bacteria have been isolated by different independent groups more significantly from the gastrointestinal tract (GIT) of active AS and CD patients when compared to controls. Flare-ups of symptoms normally coincide with an increase in KP proliferation.[4]



IBS and SIBO
Gut dysbiosis including SIBO can cause irritable bowel syndrome (IBS). Research has linked IBS with SIBO, with the most common isolates being E. coli, Enterococcus spp. and KP within patients with SIBO.5 Studies have found that SIBO is involved in more than 50% of cases of IBS and in one study it was 84%[5,6]

Symptom severity can vary from person to person depending on the extent of the KP infection, or even what type of infection in the case of SIBO. SIBO can be mild, moderate or severe and the symptoms often correlate with the severity of bacterial overgrowth. Symptoms can also change on a day to day basis depending on the diet and the level of overgrowth. Most common symptoms include abdominal pain, discomfort, bloating, constipation, diarrhoea, flatulence, nausea, heartburn, reflux, headaches, joint and muscle pain, fatigue, weakness, steatorrhoea and histamine intolerance.

Other symptoms of SIBO and IBS can include neurological imbalances such as brain fog, OCD, ADD/ADHD, depression, anxiety, poor memory and concentration. More severe symptoms include malabsorption, malnutrition, weight loss and anaemia.

It has also been demonstrated tha tgram-negative bacterium, such as Klebsiella spp. in SIBO, may produce toxins that damage the mucosa, interfering with absorptive function and causing secretions which may mimic other GIT infections.[7]

Risk factors include taking medications that reduce stomach acid (hypochlorhydria) or the natural decline of gastric acid, antibiotic use, age, metabolic disorders, coeliac disease, chronic diarrhoea and other organ dysfunction such as renal failure and pancreatitis.[7]

Infant colic
Researchers from The University of Texas Health Science Center, Houston, found a link between colic and the gut, specifically the presence of KP with associated gut inflammation in colicky infants. Babies with a higher level of healthy bacteria didn’t have colic. The findings showed that the gut inflammation seen in these babies closely resembled the GIT of patients suffering with inflammatory bowel disease (IBD). It was suggested that this finding may then increase their chances of developing GIT diseases later in life.[8] Treating babies with colic with probiotics will likely reduce the incidence of other pathogenic bacterium such as KP. More severe complications can occur with KP for people who have diabetes, chronic lung disease, alcoholism, cancer and/or are immunocompromised.

Prevention is key

  • Maintain a good balance of intestinal flora with Saccharromyces boulardii and broad spectrum probiotics after any antibiotic treatments. SB may be taken effectively alongside antibiotics.
  • Support a healthy microbiome with probiotics, fermented foods and a diet high in prebiotics and fibre.
  • Avoiding high carbohydrate diets, particularly in sugars and refined carbohydrates.             
  • Reinforce a strong immune system with adequate vitamin A, selenium, zinc, vitamin C and antioxidants.
  • Adequate rest and sleep for immune support.
  • Drinking filtered water can reduce chlorine consumption (which can destroy gut flora).
  • Hand washing is important before preparing and eating food.
  • Avoid antibiotics where possible.

Treatments
Conventional treatment for KP is normally the prescription of a combination of several powerful antibiotics particularly in the case of resistant strains of KP.

Natural treatments for KP infections along with immune support include:
Saccharromyces boulardii (SB) discourages the growth of unfriendly microorganisms such as KP. It also reduces digestive inflammatory mediators, increases the production of secretory IgA (slgA), short-chain fatty acids and the activity of the brush border disaccharide digestive enzymes. Given the opportunistic attribute of KP, SB can help to balance KP overgrowth by enhancing growth of beneficial bacteria.

Broad spectrum probiotics assist in the maintenance of healthy intestinal flora and healthy digestive function. Lactobacillus acidophilus, L. plantarum and Bifidobacterium breve may provide temporary symptomatic relief of IBS. L. acidophilus, B. breve and Streptococcus thermophilus may provide temporary relief of diarrhoea. L. fermentum and L. rhamnosus have been clinically demonstrated to assist in the maintenance of healthy urogenital flora thus reducing the incidence of urinary tract infections occurring as a result of KP infection. Zinc, vitamins A and C have demonstrated roles in the maintenance of a healthy immune system to enhance its ability to fight infection.

Immune enhancing and antimicrobial herbal medicines will help to support immune function and act as natural antibacterial agents, including Andrographis paniculata (andrographis), Hydrastis canadensis (golden seal) and Thymus vulgarise (thyme). Andrographis, thyme and golden seal are indicated for bacterial intestinal infections, while andrographis has demonstrated its ability to also destroy biofilms that bacteria build around themselves to protect themselves from antibacterial agents.[9]

Zingiber officinale (ginger) has been shown in combination with honey to reduce KP. According to researchers from Ethiopia’s College of Medicine at the University of Gondar, a combination of honey and ginger extract powder inhibits the growth of methicillin-resistant Staphylococcus aureus (MRSA), E. coli and KP.[10] Curcumin, derived from Curcuma longa (turmeric) has been shown in studies to reduce pulmonary inflammation and damage during and post KP infections due to its anti-inflammatory actions.[11]

Oregano oil has been shown to kill species of KP in studies and demonstrates anti-inflammatory actions along with specific antibacterial effects.[12]

Consumption of apple cider vinegar to enhance gastric acid secretions in combination with digestive enzymes may reduce the incidence of KP GIT infections.

A low starch diet has also be shown to be effective in reducing intestinal KP infections, particularly in cases of AS and IBD and can help manage the associated disease symptoms.[4]

References:

  1. Harris P, Paterson D, Rogers B. Facing the challenge of multidrug-resistant gram-negative bacilli in Australia. MJA 2015;202(5):243-247. [Full Text]
     
  2. Leang K, Sultana I, Takada G, et al. A novel bioconversion of L-fructose to L-glucose by Klebsiella pneumoniae. J Biosci Bioeng 2003;95(3):310-312. [Abstract]
     
  3. Qureshi S. Klebsiella infections. Medscape 2016. Viewed 4 May 2017, [Full Text]
     
  4. Rashid T, Wilson C, Ebringer A. The link between ankylosing spondylitis, Crohn’s disease, Klebsiella, and starch consumption. Clin Dev Immunol 2013;2013: 872632. [Full Text]
     
  5. Pyleris E, Giamarellos-Bourboulis EJ, Tzivras D, et al. The prevalence of overgrowth by aerobic bacteria in the small intestine by small bowel culture: relationship with irritable bowel syndrome. Dig Dis Sci 2012;57(5):1321-1329.[Abstract]
     
  6. Pimentel M, Chow EJ, Lin HC. Normalization of lactulose breath testing correlates with symptom improvement in irritable bowel syndrome. a double-blind, randomized, placebo-controlled study. Am J Gastroenterol 2003;98(2):412-419. [Abstract]
     
  7. Dukowicz AC, Lacy BE, Levine GM.. Small intestinal bacterial overgrowth: a comprehensive review. Gastroenterol Hepatol (N Y) 2007;3(2):112–122. [Abstract]
     
  8. Rhoads M, University of Texas Health Science Center at Houston. Colic In babies may be caused by gut gacteria. ScienceDaily25 July 2009. Viewedd 4 May 2017 [Source]
     
  9. Jiang X, Yu P, Jiang J, et al. Synthesis and evaluation of antibacterial activities of andrographolide analogues. Eur J Med Chem 2009;44(7):2936-2943. [Abstract]
     
  10. Ewnetu Y, Lemma W, Birhane N. Synergetic antimicrobial effects of mixtures of ethiopian honeys and ginger powder extracts on standard and resistant clinical bacteria isolates. Evid Based Complement Alternat Med 2014;2014:562804. [Abstract]
     
  11. Bansal S, Chhibber S. Curcumin alone and in combination with augmentin protects against pulmonary inflammation and acute lung injury generated during Klebsiella pneumoniae B5055-induced lung infection in BALB/c mice. J Med Microbiol 2010;59(Pt 4):429-437. [Abstract]
     
  12. Chaudhry NMA, Saeed S, Tariq P. Antibacterial effects of oregano (origanum vulgare) against gram negative bacilli. Pak J Bot 2007;39(2):609-613. [Abstract]

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claire_georgiou's picture
Claire Georgiou
Claire Georgiou is an Australian Naturopath, Nutritionist and Herbalist. Claire has completed a Bachelor of Health Science (C.Med) and an Advanced Diploma of Naturopathy, Herbal Medicine and Nutrition.