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44-405: VHP may refer to: Vaporized hydrogen peroxide Vassar Haiti Project , a nonprofit organization promoting Haitian art Veteran's Heritage Project Veterans History Project Volcano Hazards Program Vishva Hindu Parishad , an international Hindu organisation Progressive Reform Party (Suriname) ( Vooruitstrevende Hervormingspartij ),

88-523: A case-by-case basis, as there are currently no international guidelines. To get a K. pneumoniae infection, a person must be exposed to the bacteria . In other words, K. pneumoniae must enter the respiratory tract to cause pneumonia, or the blood to cause a bloodstream infection. In healthcare settings, K. pneumoniae bacteria can be spread through person-to-person contact (for example, contaminated hands of healthcare personnel, or other people via patient to patient) or, less commonly, by contamination of

132-506: A large number of anti-microbial resistance genes (AMR genes). These genes are transferred via plasmids from and to other human pathogens. One human pathogen that commonly acquires AMR genes from Klebsiella pneumoniae is Salmonella . This could help with treatment of salmonella infections due to having knowledge of possible antibiotic resistance data. The majority of AMR genes in Klebsiella pneumoniae are plasmid-borne. An example of

176-416: A large virulence plasmid and potentially on additional conjugative elements. These newly identified strains were described to overproduce capsule components and siderophores for iron acquisition, among other factors. Although initial studies showed that hvKp is rather susceptible to antibiotic treatment, it has been recently shown that such strains can acquire resistance plasmids and become multiresistant to

220-508: A maternal vaccine to prevent neonatal sepsis and global demand assessments have been published. As of June 2023, one single clinical development program for a K. pneumoniae vaccine [Kleb4V/GSK4429016A] was in a Phase 1/2 study in healthy adults aged 18–70 yrs (n=166) [Clinical trials identifier: NCT04959344]. The vaccine is an O-antigen based conjugate where the specific O-antigens in the vaccine remain undisclosed [Michael Kowarik, LimmaTech Biologics, World Vaccine Congress EU, 2022] although only

264-697: A mucoid lactose fermenter on MacConkey agar . Although found in the normal flora of the mouth, skin, and intestines, it can cause destructive changes to human and animal lungs if aspirated, specifically to the alveoli, resulting in bloody, brownish or yellow colored jelly-like sputum . In the clinical setting, it is the most significant member of the genus Klebsiella of the Enterobacteriaceae . K. oxytoca and K. rhinoscleromatis have also been demonstrated in human clinical specimens. In recent years, Klebsiella species have become important pathogens in nosocomial infections. It naturally occurs in

308-460: A nationwide treatment plan. The intervention entailed physical separation of all CRE carriers and appointment of a task force to oversee efficacy of isolation by closely monitoring hospitals and intervening when necessary. After the treatment plan (measured in May 2008), the number of cases per 100,000 patient days decreased to 11.7. The plan was effective because of strict hospital compliance, wherein each

352-752: A niche would be soil, often considered a hotspot for gene transfer. The table shows the number of AMR genes and plasmids (per strain or subspecies) compared to other common bacteria species. To prevent spreading Klebsiella infections between patients, healthcare personnel must follow specific infection-control precautions, which may include strict adherence to hand hygiene (preferably using an alcohol based hand rub (60–90%) or soap and water if hands are visibly soiled. Alcohol based hand rubs are effective against these Gram-negative bacilli) and wearing gowns and gloves when they enter rooms where patients with Klebsiella -related illnesses are housed. Healthcare facilities also must follow strict cleaning procedures to prevent

396-707: A political party in Suriname Civic Solidarity Party ( Vətəndaş Həmrəyliyi Partiyası ), a political party in Azerbaijan Topics referred to by the same term [REDACTED] This disambiguation page lists articles associated with the title VHP . If an internal link led you here, you may wish to change the link to point directly to the intended article. Retrieved from " https://en.wikipedia.org/w/index.php?title=VHP&oldid=1030796758 " Category : Disambiguation pages Hidden categories: Short description

440-523: A porin mutation or drug efflux, and carbapenemase production. The most important mechanism of resistance by CRKP is the production of a carbapenemase enzyme, blak pc. The gene that encodes the blak pc enzyme is carried on a mobile piece of genetic material (a transposon ; the specific transposon involved is called Tn4401), which increases the risk for dissemination. CRE can be difficult to detect because some strains that harbor blak pc have minimum inhibitory concentrations that are elevated, but still within

484-453: A risk; neonatal ward devices, respiratory support equipment, and urinary catheters put patients at increased risk. Also, the use of antibiotics can be a factor that increases the risk of nosocomial infection with Klebsiella bacteria. Sepsis and septic shock can follow entry of the bacteria into the blood. Research conducted at King's College, London has implicated molecular mimicry between HLA-B27 and two Klebsiella surface molecules as

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528-444: A sterilant, VHP is one of the chemicals approved for decontamination of anthrax spores from contaminated buildings, such as occurred during the 2001 anthrax attacks in the U.S. It has also been shown to be effective in removing exotic animal viruses, such as avian influenza and Newcastle disease from equipment and surfaces. VHP is produced from a solution of liquid H 2 O 2 and water, by generators specifically designed for

572-434: A variety of antibiotics. It originated from Asia , having a high mortality rate among the population. It often spreads to central nervous system and eye causing endophthalmitis , nonhepatic abscesses, pneumonia , necrotizing fasciitis , and meningitis . One visual trait of these strains is hypermucoviscous phenotype and a string test can be used to help the diagnosis. Further examinations and treatments are made on

616-439: Is a rather recent K pneumoniae variant that is significantly more virulent than classical K. pneumoniae (cKp). While cKp is an opportunistic pathogen responsible for nosocomial infections that usually affect immunocompromised patients, hvKp is clinically more concerning since it also causes disease in healthy individuals and can infect virtually every site of the body. The genetic traits that lead to this pathotype are included in

660-525: Is also unknown, but has been observed to be as high as 44%. The Centers for Disease Control and Prevention released guidance for aggressive infection control to combat CRKP: In 2019, there were 192,530 global deaths attributed to resistant strains of Klebsiella pneumoniae . Israel 2007–2008 . A nationwide outbreak of CRE in Israel peaked in March 2007 at 55.5 cases per 100,000 patient days and necessitated

704-474: Is believed to have impaired respiratory host defenses, including persons with diabetes , alcoholism , malignancy , liver disease, chronic obstructive pulmonary diseases , glucocorticoid therapy, kidney failure , and certain occupational exposures (such as papermill workers). Many of these infections are obtained when a person is in the hospital for some other reason (a nosocomial infection ). In addition to pneumonia, Klebsiella can also cause infections in

748-495: Is different from Wikidata All article disambiguation pages All disambiguation pages Vaporized hydrogen peroxide VHP is registered by the U.S. Environmental Protection Agency as a sterilant , which the EPA defines as "a substance that destroys or eliminates all forms of microbial life in the inanimate environment, including all forms of vegetative bacteria, bacterial spores, fungi, fungal spores, and viruses". As

792-653: Is emerging as an important challenge in health-care settings. One of many CREs is carbapenem-resistant Klebsiella pneumoniae (CRKP). Over the past 10 years, a progressive increase in CRKP has been seen worldwide; however, this new emerging nosocomial pathogen is probably best known for an outbreak in Israel that began around 2006 within the healthcare system there. In the US, it was first described in North Carolina in 1996; since then CRKP has been identified in 41 states; and

836-482: Is not likely to be as troublesome as to antibiotics as new infectious phages are likely to be available in environmental reservoirs. Phage therapy can be used in conjunction with antibiotics, to supplement their activity instead of replacing it altogether. New data sources outlining the global burden of K. pneumoniae and drug-resistant forms are expected to build momentum into prophylactic vaccine development. The recent 2022 IHME study showed that in 2019 K. pneumoniae

880-584: Is routinely detected in certain hospitals in New York and New Jersey. It is now the most common CRE species encountered within the United States. CRKP is resistant to almost all available antimicrobial agents, and infections with CRKP have caused high rates of morbidity and mortality, in particular among persons with prolonged hospitalization and those critically ill and exposed to invasive devices (e.g., ventilators or central venous catheters). The concern

924-547: Is that carbapenem is often used as a drug of last resort when battling resistant bacterial strains. New slight mutations could result in infections for which healthcare professionals can do very little, if anything, to treat patients with resistant organisms. A number of mechanisms cause carbapenem resistance in the Enterobacteriaceae. These include hyperproduction of ampC beta-lactamase with an outer membrane porin mutation, CTX-M extended-spectrum beta-lactamase with

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968-894: The beta-lactamase with clavulanic acid have been reported. Infections due to multidrug-resistant gram-negative pathogens in the ICU have invoked the re-emergence of colistin . However, colistin-resistant strains of K. pneumoniae have been reported in ICUs. In 2009, strains of K. pneumoniae with gene called New Delhi metallo-beta-lactamase ( NDM-1 ) that even gives resistance against intravenous antibiotic carbapenem , were discovered in India and Pakistan . Klebsiella cases in Taiwan have shown abnormal toxicity, causing liver abscesses in people with diabetes mellitus (DM); treatment consists of third generation cephalosporins . Hypervirulent (hvKp)

1012-403: The urinary tract, lower biliary tract, and surgical wound sites. The range of clinical diseases includes pneumonia, thrombophlebitis , urinary tract infection , cholecystitis , diarrhea , upper respiratory tract infection , wound infection, osteomyelitis , meningitis , and bacteremia , and sepsis . For patients with an invasive device in their bodies, contamination of the device becomes

1056-882: The VHP has circulated in the enclosed space for a pre-defined period, it is circulated back through the generator, where it is broken down into water and oxygen by a catalytic converter until concentrations of VHP fall to safe levels (typically <1 ppm). Alternatively, the VHP is vented to the outside air, in cases where recapturing of the VHP is not needed. Vaporized hydrogen peroxide has been investigated as an airborne disinfectant and infection control measure for hospitals and has been shown to reduce incidence of nosocomial infections from several pathogens. Clostridioides difficile associated disease, VRE and MRSA are all associated with environmental contamination. H 2 O 2 vapor has been used in hospitals to eradicate causal agents, e.g. , antibiotic-resistant Klebsiella pneumoniae , from

1100-623: The body and cause infection. Klebsiella organisms are often resistant to multiple antibiotics. Current evidence implicates plasmids as the primary source of the resistance genes. Klebsiella species with the ability to produce extended-spectrum beta-lactamases ( ESBL ) are resistant to virtually all beta-lactam antibiotics, except carbapenems. Other frequent resistance targets include aminoglycosides , fluoroquinolones , tetracyclines , chloramphenicol , and trimethoprim/sulfamethoxazole . Infection with carbapenem-resistant Enterobacteriaceae (CRE) or carbapenemase -producing Enterobacteriaceae

1144-419: The cause of ankylosing spondylitis . Klebsiella ranks second to E. coli for urinary tract infections in older people. It is also an opportunistic pathogen for patients with chronic pulmonary disease, enteric pathogenicity, nasal mucosa atrophy, and rhinoscleroma . New antibiotic-resistant strains of K. pneumoniae are appearing. The most common condition caused by Klebsiella bacteria outside

1188-400: The diagnosis of Klebsiella pneumoniae the following can be done to determine if the individual has this infection, with the addition of susceptibility testing to identify drug-resistant organisms: Treatment for Klebsiella pneumoniae is by antibiotics such as aminoglycosides , piperacillin/tazobactam , and cephalosporins , the choice depending upon antibiotic susceptibility testing ,

1232-447: The environment and prevent infection of subsequent patients. OSHA mandates a PEL of 1.0 ppm (1.4 mg/m ) for HPV. Typically, safe working environments around sterilization equipment is achieved with electrochemical sensors capable of measuring in the parts per billion and low parts per million levels. These sensors are typically inexpensive and limited to ambient conditions. Moreover, HPV electrochemical sensors are often located near

1276-411: The environment; the role of transmission directly from the environment to patients is controversial and requires further investigation. However, the bacteria are not spread through the air. Patients in healthcare settings also may be exposed to K. pneumoniae when they are on ventilators , or have intravenous catheters or wounds. These medical tools and conditions may allow K. pneumoniae to enter

1320-522: The hospital is pneumonia , typically in the form of bronchopneumonia and also bronchitis . These patients have an increased tendency to develop lung abscesses , cavitation, empyema , and pleural adhesions . It has a death rate around 50%, even with antimicrobial therapy. It is typically due to aspiration and alcoholism may be a risk factor, though it is also commonly implicated in hospital -acquired urinary tract infections , and COPD (chronic obstructive pulmonary disease) individuals. In terms of

1364-445: The infection. More specific treatments of Klebsiella pneumonia are given in its section above. For urinary tract infections with multidrug-resistant Klebsiella species, a combination therapy with amikacin and meropenem has been suggested. Multiple drug-resistant K. pneumoniae strains have been killed in vivo by intraperitoneal, intravenous, or intranasal administration of phages in laboratory tests. Resistance to phages

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1408-513: The pathophysiology of Klebsiella pneumonia the neutrophil myeloperoxidase defense against K. pneumoniae is often seen. Oxidative inactivation of elastase is involved, while LBP helps transfer bacteria cell wall elements to the cells. Individuals with Klebsiella pneumoniae tend to cough up a characteristic sputum , as well as having fever, nausea , tachycardia , and vomiting . Klebsiella pneumoniae tends to affect people with underlying conditions, such as alcoholism . In terms of

1452-418: The person's health condition, medical history and severity of the disease. Klebsiella possesses beta-lactamase giving it resistance to ampicillin . Many strains have acquired an extended-spectrum beta-lactamase with additional resistance to carbenicillin , amoxicillin , and ceftazidime. The bacteria remain susceptible to aminoglycosides and some cephalosporins , and varying degrees of inhibition of

1496-414: The purpose. These generators initially dehumidify the ambient air, then produce VHP by passing aqueous hydrogen peroxide over a vaporizer, and circulate the vapor at a programmed concentration in the air, typically from 140 ppm to 1400 ppm, depending on the infectious agent to be cleared. By comparison, a concentration of 75 ppm is considered to be "Immediately Dangerous to Life or Health" in humans. After

1540-459: The same year, she developed septic shock and died. On testing by CDC an isolate from the patient was found to be resistant to all 26 antibiotics available in the US, including drug of last resort colistin . It is believed she may have picked up the microbe while hospitalized in India for two years due to a broken right femur and subsequent femur and hip infections. Klebsiella pneumoniae carries

1584-485: The soil, and about 30% of strains can fix nitrogen in anaerobic conditions. As a free-living diazotroph , its nitrogen-fixation system has been much-studied, and is of agricultural interest, as K. pneumoniae has been demonstrated to increase crop yields in agricultural conditions. It is closely related to K. oxytoca from which it is distinguished by being indole -negative and by its ability to grow on melezitose but not 3-hydroxybutyrate . The genus Klebsiella

1628-431: The spread of Klebsiella . To prevent the spread of infections, patients also should clean their hands very often, including: K. pneumoniae can be treated with antibiotics if the infections are not drug-resistant . Infections by K. pneumoniae can be difficult to treat because fewer antibiotics are effective against them. In such cases, a microbiology laboratory must run tests to determine which antibiotics will treat

1672-429: The sterilization chamber during the sterilization cycle can be challenging. Technical issues such as condensation, vacuum, and high concentration have prevented many sensing technologies such as electrochemical sensors from providing real-time monitoring of H 2 O 2 concentration. Under these conditions, optical methods such as spectroscopy can be used to ensure that lethal concentrations of H 2 O 2 are achieved in

1716-444: The sterilization chamber. Hydrogen peroxide vapors and fumes can irritate and damage the skin, the respiratory tract, and the eyes. Extreme precautions must be taken when manipulating hydrogen peroxide, and it must not be considered harmless. Klebsiella pneumoniae Klebsiella pneumoniae is a Gram-negative , non-motile, encapsulated , lactose - fermenting , facultative anaerobic , rod-shaped bacterium . It appears as

1760-541: The sterilization equipment to detect possible leaks during the sterilization cycle. In 2014, Advanced Sterilization Products (ASP), sovaldi the manufacturer of the Sterrad hydrogen peroxide gas plasma sterilizer, issued a letter to hospital risk managers warning them that hydrogen peroxide residues may be found in the sterilization load. HPV being present in the sterilization load, could lead the accidental exposure of hospital staff. Monitoring hydrogen peroxide levels inside

1804-429: The susceptible range for carbapenems. Because these strains are susceptible to carbapenems, they are not identified as potential clinical or infection control risks using standard susceptibility testing guidelines. Patients with unrecognized CRKP colonization have been reservoirs for transmission during nosocomial outbreaks. The extent and prevalence of CRKP within the environment is currently unknown. The mortality rate

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1848-702: Was named after the German microbiologist Edwin Klebs (1834–1913). It is also known as Friedlander's bacillum in honor of Carl Friedländer , a German pathologist, who proposed that this bacterium was the etiological factor for the pneumonia seen especially in immunocompromised individuals such as people with chronic diseases or alcoholics. Community-acquired pneumonia caused by Klebsiella pneumoniae may occasionally be called Friedländer's pneumonia . Illness most commonly affects middle-aged and older men more often than women with debilitating diseases. This patient population

1892-484: Was required to keep detailed documentation of all CRE carriers. In fact, for each increase in compliance by 10%, incidence of cases per 100,000 patient days decreased by 0.6. Therefore, containment on a nationwide scale requires nationwide intervention. Nevada 2016 . In mid-August 2016, a resident of Washoe County was hospitalized in Reno due to a CRE (specifically Klebsiella pneumoniae ) infection. In early September of

1936-495: Was responsible for 790,000 deaths [571,000–1,060,000] in all age groups across 11 infectious syndromes. Importantly, in Sub-saharan Africa K. pneumoniae was responsible for 124,000 [89,000–167,000] neonatal deaths due to bloodstream infections. Based on these and other data, a newly developed prophylactic vaccine would ideally be designed to prevent invasive K. pneumoniae disease in both vulnerable persons but also as

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