Klebsiella bacteria in the throat

Question

My daughter (14 months, CF) had a throat swab done in which klebsiella bacteria were found. The doctors said these bacteria were sensitive to cefuroxime and that I should give my daughter this antibiotic. However, she has already been taking it for three months anyway in order to get through the winter well. This means she has acquired the klebsiella bacteria during the antibiotic therapy, since they were not present in a swab done three months ago.

What kind of bacteria are they exactly? What are the chances to get them under control with cefuroxime?

On the other hand, they are after all linked with ESBL. How high is the risk that the next swab will show ESBL?

Can we do anything at home in addition to giving her the antibiotic? Fighting the bacteria? Hygienic measures? Additional therapy?

Thank you for your answer!

Answer

Hello,

the answer to your question is not easy. Klebsiella are ubiquitous bacteria which belong to the regular flora in the respiratory tracts, among others. On the other hand, it is also known that klebsiella (e.g. klebsiella pneumoniae) can cause pneumonia. The question why these germs were able to colonize your daughter’s throat despite the antibiotic which should actually be effective against them is not easy to answer. Perhaps the cefuroxime dosage you were supposed to give her was rather low (since it was only intended as prophylaxis) and does not correspond to the necessary highly-dosed antibiotics therapy in CF. Now, however, the doctors will surely recommend such a highly-dosed therapy for eradication. After all, especially in CF patients, there are regions in the body in which the prophylactic dosage of an antibiotic is not always sufficient to kill all germs, which will allow some germs to survive and get selected. It is probably impossible to get all mucous membranes completely germ-free. Of course, I cannot negate your question whether these germs might suddenly become a problem for your child. As usual with patients like her, one has to be careful and it is important to repeat the throat swab. Perhaps the germ count is low, so that one should think about whether an effective therapy is really necessary now. Maybe the cefuroxime has actually already reduced the amount of klebsiella. In case one decides for a therapy, however, I would prefer switching to another antibiotic, also in order to avoid the formation of resistance (ESBL). I hope that the antibiogram of the germ will offer other options.

Kind regards,
Olaf Sommerburg

07.05.2012