Abstract
The Gram-negative opportunistic pathogen, Klebsiella pneumoniae, is responsible for causing a spectrum of community-acquired and nosocomial infections and typically infects patients with indwelling medical devices, especially urinary catheters, on which this microorganism is able to grow as a biofilm. The increasingly frequent acquisition of antibiotic resistance by K. pneumoniae strains has given rise to a global spread of this multidrug-resistant pathogen, mostly at the hospital level. This scenario is exacerbated when it is noted that intrinsic resistance to antimicrobial agents dramatically increases when K. pneumoniae strains grow as a biofilm. This review will summarize the findings about the antibiotic resistance related to biofilm formation in K. pneumoniae.
Highlights
Klebsiella pneumoniae was isolated for the first time in 1882 by Friedlander from the lungs of patients who died after pneumonia
The virulence factors playing an important role in the severity of K. pneumoniae infections are capsular polysaccharides, type 1 and type 3 pili, factors involved in aggregative adhesions and siderophores [3,4,5,6], with those studied in greater depth being capsular polysaccharides and type 1 and type 3 pili
K. pneumoniae was reported to be able to grow in vitro as a biofilm since the end of the 1980s [57], but clear evidence of an in vivo biofilm was provided only in 1992 by Reid and coworkers, who investigated by scanning electron microscopy some bladder epithelial cells of a spinal cord injured patient with an asymptomatic urinary tract infection caused by K. pneumoniae [58]
Summary
Klebsiella pneumoniae was isolated for the first time in 1882 by Friedlander from the lungs of patients who died after pneumonia. Its considerable efficiency of colonization, accompanied by acquired resistance to antibiotics, has enabled K. pneumoniae to persist and spread rapidly in healthcare settings, the most common healthcare-associated infections caused by this agent involving the urinary tract, wounds, lungs, abdominal cavity, intra-vascular devices, surgical sites, soft tissues and subsequent bacteremia [3,29,30,31]. Klebsiella is second only to Escherichia coli in nosocomial Gram-negative bacteremia [32], as well as in urinary tract infections (UTIs), affecting catheterized patients (16% and 70%, respectively) [33]. A cohort study indicated that the majority of infections associated with different medical devices, including both urinary and intravascular catheters, was caused by K. pneumoniae followed by staphylococcal biofilms, and a high percentage (about 90%) of biofilm-producing bacterial isolates causing infection were multidrug resistant [39]. Gram-negative pathogens, after P. aeruginosa [43]
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