Klebsiella - The family Enterobacteriaceae: the largest, most heterogeneous collection of

Proteus medically important gram-negative rods

Yersinia = enterics / coliforms

- gram-negative bacilli or coccobacilli

The major groups of - non– spore forming

Enterobacteriaceae are:
- facultative anaerobes

1. Escherichia **the most - capable of fermenting glucose

common 
 - oxidase negative (exceptions)

2. Klebsiella–Enterobacter– - catalase positive

Serratia group- Hafnia 
 - reduce nitrates to nitrites

3. Proteus–Morganella–
The enteric bacteria:

Providencia group 

- sometimes found in small numbers as part of the normal microbiota of the upper
4. Citrobacter 
 respiratory & genital tracts.

5. Shigella 
 - generally do not cause disease

6. Salmonella
- in the intestine contribution to normal function & nutrition.

7. Other - hospital-acquired infections & occasionally community-acquired infections

Enterobacteriaceae - pathogenic only when reaching tissues outside of their normal intestinal or other
(Yersinia spp, Cronobacter, less common normal microbiota sites

Edwardsiella, - The most frequent sites of clinically important infection: the urinary tract, biliary
Ewingella,Hafnia, Cedecea, tract, and other sites in the abdominal cavity

Plesiomonas, and Kluyvera) 
 but any anatomic site (bloodstream, prostate gland, lung, bone, meninges) = the
site of disease

- Some of the enteric bacteria (eg, Serratia marcescens, E.aerogenes) =

opportunistic pathogens.

- inadequate normal host defenses— particularly in infancy or old age, in the

terminal stages of other diseases, after immunosuppression, or with indwelling
venous or urethral catheters

=localized clinically important infections & sepsis (the bacteria reaching the
bloodstream)
Klebsiella - found in gastrointestinal & upper respiratory tract - the normal flora.

- don’t cause GIT infections.

- big, non-motile and capsular bacteria.

a prominent mucoid polysaccharide capsule: Virulence factor & Protection from

phagocytosis

- Klebsiella species rank among the top 10 bacterial pathogens responsible for
hospital-acquired infections.

- MacConkey Agar; pink colored colonies due to the lactose fermentation

- mucoid growth (M colonies), large polysaccharide capsules, and lack of motility

- positive test results for lysine decarboxylase & citrate

- nonmotile (The absence of motility distinguishes Klebsiella spp. from most other
members of the family Enterobacteriaceae )

- Siderophore Production- iron from host

- IMViC (-, -, +, +)

- H2S negatif

7 species in Klebsiella genus;

- Klebsiella pneumoniae
- Klebsiella oxytoca
- Klebsiella ozaenae
- Klebsiella rhinoscleromatis
- Klebsiella planticola

- Klebsiella terrigena

- Klebsiella ornithinolytica.
Klebsiella pneumoniae - widely distributed in nature & low level colonization of healthy individuals

- in the respiratory tract & feces of about 5% of normal individuals

- a small proportion (~1%) of bacterial pneumonias

- production of extensive hemorrhagic necrotizing pneumoniae (consolidation of

the lung) – typically severe destructive changes in lungs = necrosis, inflammation,
hemorrhage of the lung tissues.

- Production of urinary tract infections & bacteremia with focal lesions in debilitated
patients.

- Klebsiella spp - among the top 10 bacterial pathogens responsible for hospital-
acquired infections.

- The bacteria in this genus cause both community- and hospital-acquired

pneumonia

- Patients requires care devices like ventilators (breathing machines) or intravenous

(vein) catheters & patients taking long courses of certain antibiotics = most at risk
for Klebsiella infections.

- K. pneumoniae - frequent cause of lower respiratory tract infections among

hospitalized patients & in immunocompromised hosts (newborns, elderly patients
& seriously ill patients on respirators)

- Other infections commonly associated with K. pneumoniae involving

immunocompromised hosts = wound infections, UTIs, liver abscesses, and
bacteremia.

- hospital-acquired outbreaks of Klebsiella resistant to multiple antimicrobial

agents in newborn nurseries.

= the plasmid transfer of antimicrobial resistance

- Low birthweight, prematurity, prolonged hospitalization, underlying conditions-

the important risk factors of K.pneumoniae infection in newborns

- Antibiotic resistant strains !!!!!

• All strains of K. pneumoniae = resistant to ampicillin.

• Multiple antibiotic resistance patterns from the acquisition of multidrug-resistant

plasmids

• Multilocus sequencing typing - identified global emergence of two particularly

important clones.

• Sequence type 16: elaborated extended spectrum β-lactamases (ESBL’s)

resulting in resistance to a broad range of penicillins and cephalosporins (but not
carbapenem antibiotics = imipenem, meropenem used in treatment ).

• ST258 : a multidrug resistant strain called a “carbapenamase producer”

= resistant to all β-lactam antibiotics including the broad spectrum carbapenem

agents.

• The term “KPC” or K. pneumoniae–producing carbapenemases: plasmids

carrying multiple resistance genes
2 other Klebsielleae K.pneumoniae subspecies ozaenae: isolated from the nasal mucosa in ozena, a
associated with inflammatory smelly, progressive atrophy of mucous membranes.

conditions of the upper K.pneumoniae subspecies rhinoscleromatis form rhinoscleroma: a destructive

respiratory tract: granuloma of the nose and pharynx.

Klebsiella granulomatis (formerly Calymmatobacterium granulomatis) = a chronic

genital ulcerative disease, granuloma inguinale, an uncommon sexually transmitted
disease.

- Some strains of K. oxytoca carrying a heatlabile cytotoxin isolated from patients

developed a self-limiting antibiotic- associated hemorrhagic colitis.

- Similar to K. pneumoniae : distinguished by indole production

- Nosocomial infections

- ESBL (extended spectrum β-lactamase)

Enterobacter - motile (peritrichous flagella)

- lactose fermenter

- capsules that produce mucoid colonies,

- ornithine decarboxylase–positive, ü

- no H2S production 


The genus Enterobacter - composed of at least 12 species.

- Enterobacter cloacae (most common)

- Enterobacter aerogenes (most common)

- Enterobacter gergoviae

- Enterobacter hormaechei

- Enterobacter agglomerans

- Enterobacter sakazakii (now in the genus Cronobacter)

natural environments (soil, water, and plants), animal hosts (vertebrates and
invertebrates), clinical environments and patients, home and industrial
environments, as well as foods.
Enterobacter sakazakii - Production of a yellow pigment

- documented as a pathogen in neonates causing meningitis and bacteremia, often

coming from powdered infant formula.

Pantoea agglomerans = - belongs to Enterobacteriaceae

Enterobacter agglomerans - an be isolated from feculent material, plants, and soil;pathogens or commensals

- the most commonly isolated species in humans, resulting in soft tissue or bone/
joint infections following penetrating trauma by vegetation

- lysine-, ornithine-, and arginine-negative = “triple decarboxylases-negative»

- Production of a yellow pigment

- primarily a plant pathogen.

Enterobacter - a broad range of hospital-acquired infections (pneumonia, urinary tract infections,

and wound and device infections)

- Most strains = a chromosomal β-lactamase called ampC

intrinsically resistant to ampicillin and first- and second-generation cephalosporins.

- Like K.pneumoniae, some hospital-acquired strains have plasmids that

makethem multidrug resistant including the carbapenem class of antimicrobial
agents.
Serratia marcescens - a common opportunistic pathogen in hospitalized patients.

- Serratia:

• found in soil, water, plants, and human intestine

• (usually nonpigmented) = pneumonia, bacteremia, and endocarditis (especially in

narcotics addicts) and in hospitalized patients.

• Production of DNase, lipase, and gelatinase.

• about 10% of isolates form the red pigment (prodigiosin) = long characterized
S.marcescens (at 25 C)

• Motile

• slow lactose fermenters

- S.marcescens: often multi-resistant to aminoglycosides and penicillins; infections

treated with third-generation cephalosporins.

- Serratia marcescens
- Serratia liquefaciens

- Serratia rubidaea

- Serratia fonticola

- Serratia odorifera

- Serratia plymuthica

- Serratia ficaria

Hafnia One species Hafnia alvei

two distinct biotypes: H. alvei and H. alvei biotype 1

- Biotype 1 growth in the beer wort of breweries & not isolated clinically.

- formerly Enterobacter hafniae

- Motile, Indole negative, Urease positive, degrades gelatin

- Can be isolated from many anatomic sites in humans and in the environment

- Most infections with H. alvei = indentified in patients with severe underlying

disease (malignancies) or after surgery or trauma.

- linked to gastroenteritis & occasionally isolated from stool cultures

- A delayed positive citrate reaction - major characteristic of Hafnia

Proteus–Morganella– distinguished from the other members of the Enterobacteriaceae by virtue of the
Providencia group ability to deaminate the amino acid phenylalanine.

Proteus - production of infections in humans only when the bacteria leave the intestinal
tract

- found in urinary tract infections & production of bacteremia, pneumonia, and

focal lesions in debilitated patients or those receiving contaminated intravenous
infusions.

Proteus mirabilis (indole negative) - urinary tract infections & occasionally other
infections.

Proteus vulgaris (indole positive)- nosocomial pathogen.

Proteus species:
Production of urease, resulting in rapid hydrolysis of urea with liberation of
ammonia.

Production of a very distinct fishy odour

- In urinary tract infections with Proteus species: alkaline urine - promoting stone
formation & making acidification virtually impossible (resembles staghorn)

- The rapid motility of Proteus contribution to its invasion of the urinary tract.

- Proteus species very active movement by means of peritrichous flagella,

resulting in “swarming” on solid media unless inhibited by chemicals.

- The Proteus–Providencia group ferments lactose very slowly or not at all.

Providencia - members of the normal intestinal microbiota.

- Providencia rettgeri, Providencia alcalifaciens, and Providencia stuartii

- All cause urinary tract infections & occasionally other infections - often resistant
to antimicrobial therapy.

- Pathogen of the urinary tract caused occasional outbreaks in health care

settings.

- diarrheal disease among travelers

- P. stuartii: implicated in outbreaks in burn units & isolated from urine cultures.

- Infections caused by P. stuartii and P. rettgeri, especially in immunocompromised

patients (particularly difficult to treat because of their resistance to antimicrobials)

Morganella - found ubiquitously throughout the environment & often associated with stool
specimens collected from patients with symptoms of diarrhea.

- normal inhabitants of the gastrointestinal tract.

- M. morganii commonly isolated in the clinical laboratory; however, its clinical

significance has not been clearly defined.

- Morganella spp: deaminase positive & urease positive.

Citrobacter -urinary tract infections & sepsis principally among debilitated hospitalized patients.

- Citrobacter koseri -associated with meningitis in infants less than 2 months of

age.
Yersinia - gram- negative

- catalase-, oxidase-, and indole-positive

- non– lactose fermenting

- facultative anaerobes capable of growth at temperatures ranging from 4° to 43°C.

- Non-motile

- an unusual bipolar staining

- “safety-pin” appearance

The best known human pathogens in this genus:

Yersinia pestis
- production of nonlactose-fermenting colonies on MacConkey agar
- better growth at 25°C than at 37°C.

- catalase positive

- indole, oxidase and urease negative

- Nonmotile

- the highly fatal systemic disease = plague

• the most devastating diseases in history

• urban plague with rats as reservoir

• sylvatic plague with squirrels, rabbits, and domestic animals as reservoirs

• transmitted by bites from the flea vector, direct contact with infected tissues, or
person- to-person by inhalation of Infectious aerosols from a patient with
pulmonary disease

• three distinct clinical forms: bubonic plague / septicemic plague / pneumonic

plague

Bubonic plague: characterized by incubation period of less than 1 week, followed

by development of high fever & painful swelling or bubo of regional lymph nodes
(groin or axilla) with bacteremia / High mortality rate unless promptly treated

Septicemic plague : progressively worsen as bacterial endotoxins set off an

immunologic cascade of events, ultimately leading to multiple organ failure,
respiratory distress, and DIC (Disseminated intravascular coagulation), noted by
petechiae and gangrene in the extremities (fingers, toes and nose)

Pneumonic plague: characterized by development of fever and pulmonary

symptoms within 1 to 2 days after inhalation of bacteria / high mortality rate

Yersinia enterocolitica
- non lactose-fermenting, urease positive and oxidase negative. They grow best at
25°C and are motile at 25°C but nonmotile at 37°C.

-responsible for gastroenteritis in cold weather

(1) chronic inflammation of the terminal ileum with enlargement of the mesenteric
lymph nodes resulting in “pseudoappendicitis” (primarily a disease in children);

(2) blood transfusion-related bacteremia.

- growth at 4°C: can multiply to high concentrations in blood products stored in a

refrigerator.