State of the art in typing: Klebsiella spp.

Klebsiella was first described in 1882 as the causative organism of Friedlander’s pneumonia. Today this form of pneumonia is extremely rare but members of the genus are frequently associated with endemic and epidemic infections in hospitals. Klebsiella is carried in the intestinal tract of 30-40% of humans (Bagley & Seidler, 1977) and is also often isolated from food in hospital kitchens (Cooke et al., 1980) which, when consumed on the ward, may lead to colonization of patients. In the National Survey of Infections in Hospitals, klebsiellae accounted for approximately 5% of all bacterial isolates recovered from 3433 patients and over half of them were isolated from the urinary tract (Marples, Mackintosh & Meers, 1984). Bacteraemia is a common complication of Klebsiella infection in hospital patients and in 1982 accounted for nearly 6% of all bacteraemias reported to the CDSC in the UK (Young, 1982). A n association between ankylosing spondylitis and faecal carriage of Klebsiella spp. has been postulated (Prendergast et al., 1984) and some workers suggest that molecular mimicry between HLA-B27 and klebsiella antigens is involved in the pathogenesis of reactive arthritis (Schwimmbeck, Yu & Oldstone, 1987). A high proportion of strains sent to the Central Public Health Laboratory (CPHL) for typing come from Special Care Baby Units (SCBU) and it has been suggested that this is related to feeding methods (Riser, Noone & Howard, 1980). The extensive use of antibiotics in SCBUs may also contribute to the selection and colonization of the neonatal bowel with Klebsiella. In these units the spread of a single strain may result in serious illness including septicaemia and meningitis (Hill, Hunt & Matsen, 1974).