Risk Assessment for Klebsiella Sepsis

High-Risk Patient Populations

Neutropenic patients face dramatically increased susceptibility to Klebsiella infections, as this organism represents one of the most common gram-negative pathogens causing sepsis in this population 1
HIV/AIDS and other immunosuppressive conditions substantially elevate susceptibility to recurrent gram-negative sepsis 2
Indwelling devices, including central venous catheters, urinary catheters, and dialysis catheters, dramatically increase risk 2
Chronic kidney disease and end-stage renal disease substantially increase susceptibility 2
Chronic organ dysfunction, such as liver failure and renal failure, compromises defense mechanisms against infection 3

Intensive care unit admission, especially in units with high endemic rates of resistant organisms, increases risk 3
Recent hospitalization within 3 months increases risk of colonization with resistant strains 3
Chronic care facility residence elevates risk compared to community-dwelling patients 3
Prior colonization or infection with Klebsiella or other resistant organisms is a critical predictor of subsequent infection 2

Facilities in regions where carbapenem-resistant Enterobacteriaceae are endemic require heightened surveillance 4, 5
Units with previous CRE cases identified warrant point prevalence surveys to detect colonization 4

Perform rectal/perirectal swab surveillance cultures in patients with healthcare exposures in high-risk units to detect asymptomatic colonization 2
Conduct point prevalence surveys in intensive care units, units with previous cases, and units with high broad-spectrum antimicrobial exposure when CRE is detected 4, 5
Review microbiology records for the preceding 6-12 months when a new case is identified to ensure previously unrecognized cases haven't occurred 4