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Klebsiella in urine: the norm, treatment

 

Klebsiella in urine, found during the delivery of laboratory tests, does not bode well, since gram-negative enterobacterium Klebsiella spp., Being a conditionally pathogenic microorganism, can cause many serious diseases.

While this bacterium is present in small amounts in the human microbiota, it is one of the most common nosocomial infections that can "join" during treatment in the hospital, colonizing the lungs, urinary and gall bladder, liver, kidneys, intestines. And the pathogenicity of the Klebsiella, as well as it is necessary to all opportunistic infections, is most actively manifested with weakened immunity and severe conditions, as well as in elderly patients and infants.

According to clinical studies, the main types of  klebsiella  - Klebsiella pneumoniae and Klebsiella oxytoca - are largely caused by cases of severe inflammation of the urinary tract, secondary infection of postoperative wounds, nosocomial pneumonia, bacteremia, septicemia, sepsis.

Because Klebsiella spp. Is highly resistant to many classes of antimicrobial agents, the appointment of physicians to submit a urine sample to the Klebsiella is a clear indication of the lack of effect of the antibiotics used.

Norm of Klebsiella in urine

Urine tests conducted during a medical examination are, in most cases, required to establish or clarify a diagnosis already in the presence of a pathological condition. The results obtained should be compared with the average regulatory indicators in healthy people. So, since for today the exact infectious dose of Klebsiella spp. Is unknown, the highly conditional Klebsiella norm in urine, which is adhered to in clinical diagnosis, should not be higher than 102-105 cfu in one milliliter of urine.

CFU is a colony-forming unit that microbiologists use to quantify the results (counting bacteria) in a  bacteriological study of urine sediment.

The determination of urinary tract infection at the level of significant bacteriuria is based on the presence of Klebsiella in the urine (mainly Klebsiella pneumoniae and Klebsiella oxytoca) in an amount of more than 100,000 colony forming units per milliliter, that is, over 10 5  (105) CFU / ml of urine. This value was chosen because of its high specificity for the diagnosis of true infection even in the absence of symptoms. However, several studies have found that more than 50% of women with bladder inflammation have a lower CFU count.

In men, the minimum level of Klebsiella in urine, indicating the infection, is 103 cfu / ml, and in the case of prolonged use of the catheter - no more than 102 cfu / ml.

Klebsiella pneumonia in the urine

In laboratory studies, K. Pneumoniae can be isolated from blood, pleural fluid, wound exudates, and also with nasopharyngeal samples (swabs from the nasopharynx).

But more often Klebsiella pneumonia is found in the urine. And if the body is weakened due to illness or a decrease in immunity and has become more susceptible to pathogens, then the real threat of development is:

  • - acute uncomplicated cystitis;
  • recurrent cystitis  (in young women with the amount of K. Pneumoniae 100 cfu / ml);
  • - Complicated urinary tract infection (UTI), Klebsiella in urine at 103 cfu / ml and above;
  • - Acute cystitis in young men (102-103 cfu / ml);
  • - acute pyelonephritis (105 cfu / ml and more).

Klebsiella oxytok in the urine

Klebsiella oxytoca - klebsiella oxytok in urine may also be present, but it is not isolated almost separately.

Colonies of this species Klebsiella spp. Can be found almost everywhere, however, the klebsiella oxytoca prefers to capture the surface of the skin, the mucous membrane of the nasopharynx and the large intestine.

And although this bacterium causes less pathologies than Klebsiella pneumonia, it accounts for up to 8% of all bacterial infections in Europe and North America.

Klebsiella planktikola in the urine

Klebsiella planticola - Klebsiella planktikola in urine and in other clinical materials with diagnostic purposes is not detected.

Initially K. Planticola, described in 1981, was found exclusively in aquatic, botanical and soil environments. In 1983, the bacterium was described as Klebsiella trevisanii, and in 2001 - as Raoultella planticola. And while nothing is known about the expression of the factors of its virulence, nor about the ability to colonize human tissues and organs.

However, according to a report by the Journal of Clinical Microbiology, in a recent study, K. Planticola was identified in smears from throat and rectal smears in newborns. Given that the main source of neonatal Klebsiella infections is endogenous microflora, the need for further study of this bacterium is obvious.

Klebsiella in urine in adults

Along with bacteremia, Klebsiella in urine in adults in amounts in excess of the index of analysis of 100-105 cfu / ml, causes infectious damage to the organs of the urinary system and urinary tract.

In men, the Klebsiella content in the urine, which rises to more than 1000 cfu / ml, is a sign of a urinary tract infection, with a sensitivity and specificity of 97%.

Klebsiella ranks second after E. Coli (Escherichia coli) as a cause of urinary tract infection in the elderly.

Clinical symptoms manifested when the bladder is affected in the form of an acute form of cystitis and pyelonephritis include:

  • dysuria with increased frequency of urination;
  • imperative urge with a small amount of excreted urine;
  • burning sensation during urination and sharp pains in the perineum, in the lower abdomen;
  • blunt and traumatic pain in the lumbar region;
  • urination with blood (hematuria);
  • the appearance of purulent impurity in the urine (pyuria).

Systemic symptoms, such as fever and chills, usually indicate concomitant pyelonephritis or prostatitis.

Klebsiella in the urine during pregnancy with a level of colonization of more than 105 cfu / ml causes the same symptoms. And with an index of more than 103 cfu / ml, asymptomatic bacteriuria is noted  .

Klebsiella in the urine of a child

According to the statistics of foreign clinical microbiologists, the most common causes of urinary tract infection among children are Escherichia coli (more than 62%), and Klebsiella - in second place (23%). Then follow Proteus mirabilis (7%), Citrobacter (5.4%), Staphylococcus saprophyticus (1.3%) and Candida albicans (0.4%). Moreover, E. Coli is the most common cause of UTI among children of all ages, and in the case of pathologies of the urinary system in newborns, Klebsiella in the urine of a child is revealed in 42.8% of cases.

It was also noted that in children under the age of three months with a temperature above + 38 ° C - in the absence of an obvious source of infection - mandatory analysis should be made of Klebsiella planktikola in urine. And take into account the indicator of the presence of this bacterium in 50 000 cfu / ml, although strict definitions of colony counting criteria are operational, and not absolute.

What tests are needed?

Who to contact?

Treatment of the klebsiella in the urine

Treatment of arisen because of Klebsiella spp. Infections of the urinary tract are carried out with the help of antibiotics. And the choice of the drug for a particular patient, the way of application and dosage - subject to contraindications - remains with the doctor.

Adults and children are saved from Klebsiella: Augmentin, Levofloxacin, Amoxicillin + Clavulanic acid, Amikacin, Ciprofloxacin, Cefuroxime, Nitrofurantoin monohydrate, Doxycycline monohydrate, Phosphomycin.

Symptomatic urinary tract infections complicate 1-2% of pregnancies, usually in women with persistent bacteriuria. With pyelonephritis, most pregnant women should be treated with antibiotics. Tetracyclines and fluoroquinolones should be avoided during pregnancy. And what antibiotics can be used, read more -  Cephalosporins during pregnancy

Last update: 26.06.2018
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Medical expert editor

Portnov Alexey Alexandrovich

Education: Kiev National Medical University. A.A. Bogomolets, Specialty - "General Medicine"

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