Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Clinical features, diagnosis, and treatment of Klebsiella pneumoniae infection

Wen-Liang Yu, MD
Yin-Ching Chuang, MD
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


Klebsiella pneumoniae is a member of the Klebsiella genus of Enterobacteriaceae and belongs to the normal flora of the human mouth and intestine. Of the pathogenic Klebsiella species, K. pneumoniae is the most prevalent and clinically important. Infections with K. pneumoniae are usually hospital-acquired and occur primarily in patients with impaired host defenses.

An important exception to these general observations is a community-acquired invasive primary liver abscess syndrome, which can occur in patients without any underlying predisposing medical conditions and has primarily been described in countries in East Asia, particularly Taiwan [1]. (See "Invasive liver abscess syndrome caused by Klebsiella pneumoniae".)

The epidemiology, clinical features, diagnosis, and treatment of infections due to K. pneumoniae will be reviewed here. The microbiology and pathogenesis of K. pneumoniae infection are discussed separately. (See "Microbiology and pathogenesis of Klebsiella pneumoniae infection".)


Humans are the primary reservoir for K. pneumoniae. Carrier rates of K. pneumoniae in the community range from 5 to 38 percent in stool samples and 1 to 6 percent in the nasopharynx; Klebsiella species are rarely carried on the skin [2]. Higher rates of nasopharyngeal carriage have been noted in ambulatory alcoholic patients [3]. Chinese ethnicity itself might be a major risk factor for intestinal colonization; stool carrier rates of K. pneumoniae in healthy Chinese adults ranged from 19 percent in Japan to 88 percent in Malaysia [4].

Carrier rates are markedly increased in hospitalized patients, among whom reported rates are 77 percent in the stool, 19 percent in the pharynx, and 42 percent on the hands [2]. The higher rates of colonization are primarily related to the use of antibiotics [2,5,6]. This increase in prevalence is important clinically since, in one report, Klebsiella nosocomial infection was four times higher in stool carriers compared with noncarriers [7]. Similarly, in a study of 855 patients with K. pneumoniae liver abscess in Taiwan and 3420 age- and sex-matched controls, ampicillin or amoxicillin use within the prior 30 days of diagnosis (but not the prior 31 to 90 days) was associated with an increased risk of liver abscess [8].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: May 18, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Fang CT, Lai SY, Yi WC, et al. Klebsiella pneumoniae genotype K1: an emerging pathogen that causes septic ocular or central nervous system complications from pyogenic liver abscess. Clin Infect Dis 2007; 45:284.
  2. Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev 1998; 11:589.
  3. Fuxench-López Z, Ramírez-Ronda CH. Pharyngeal flora in ambulatory alcoholic patients: prevalence of gram-negative bacilli. Arch Intern Med 1978; 138:1815.
  4. Lin YT, Siu LK, Lin JC, et al. Seroepidemiology of Klebsiella pneumoniae colonizing the intestinal tract of healthy Chinese and overseas Chinese adults in Asian countries. BMC Microbiol 2012; 12:13.
  5. Pollack M, Charache P, Nieman RE, et al. Factors influencing colonisation and antibiotic-resistance patterns of gram-negative bacteria in hospital patients. Lancet 1972; 2:668.
  6. Asensio A, Oliver A, González-Diego P, et al. Outbreak of a multiresistant Klebsiella pneumoniae strain in an intensive care unit: antibiotic use as risk factor for colonization and infection. Clin Infect Dis 2000; 30:55.
  7. Selden R, Lee S, Wang WL, et al. Nosocomial klebsiella infections: intestinal colonization as a reservoir. Ann Intern Med 1971; 74:657.
  8. Lin YT, Liu CJ, Yeh YC, et al. Ampicillin and amoxicillin use and the risk of Klebsiella pneumoniae liver abscess in Taiwan. J Infect Dis 2013; 208:211.
  9. Akoachere JF, Bughe RN, Oben BO, et al. Phenotypic characterization of human pathogenic bacteria in fish from the coastal waters of South West Cameroon: public health implications. Rev Environ Health 2009; 24:147.
  10. Jang S, Wheeler L, Carey RB, et al. Pleuritis and suppurative pneumonia associated with a hypermucoviscosity phenotype of Klebsiella pneumoniae in California sea lions (Zalophus californianus). Vet Microbiol 2010; 141:174.
  11. Castinel A, Grinberg A, Pattison R, et al. Characterization of Klebsiella pneumoniae isolates from New Zealand sea lion (Phocarctos hookeri) pups during and after the epidemics on Enderby Island, Auckland Islands. Vet Microbiol 2007; 122:178.
  12. Tang HL, Lai YC, Chiou CS, et al. Liver abscess caused by Klebsiella pneumoniae in a red-footed tortoise. J Microbiol Immunol Infect 2015; 48:347.
  13. Anderson DJ, Richet H, Chen LF, et al. Seasonal variation in Klebsiella pneumoniae bloodstream infection on 4 continents. J Infect Dis 2008; 197:752.
  14. Ko WC, Paterson DL, Sagnimeni AJ, et al. Community-acquired Klebsiella pneumoniae bacteremia: global differences in clinical patterns. Emerg Infect Dis 2002; 8:160.
  15. Tsay RW, Siu LK, Fung CP, Chang FY. Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factor for mortality and the impact of capsular serotypes as a herald for community-acquired infection. Arch Intern Med 2002; 162:1021.
  16. Kang CI, Kim SH, Bang JW, et al. Community-acquired versus nosocomial Klebsiella pneumoniae bacteremia: clinical features, treatment outcomes, and clinical implication of antimicrobial resistance. J Korean Med Sci 2006; 21:816.
  17. Lee KH, Hui KP, Tan WC, Lim TK. Klebsiella bacteraemia: a report of 101 cases from National University Hospital, Singapore. J Hosp Infect 1994; 27:299.
  18. Feldman C, Smith C, Levy H, et al. Klebsiella pneumoniae bacteraemia at an urban general hospital. J Infect 1990; 20:21.
  19. Lu CH, Chang WN, Wu HS. Klebsiella pneumoniae meningitis: analysis on clinical features of thirty-two adult patients. Zhonghua Yi Xue Za Zhi (Taipei) 1997; 60:296.
  20. Watanakunakorn C, Jura J. Klebsiella bacteremia: a review of 196 episodes during a decade (1980-1989). Scand J Infect Dis 1991; 23:399.
  21. Hansen DS, Gottschau A, Kolmos HJ. Epidemiology of Klebsiella bacteraemia: a case control study using Escherichia coli bacteraemia as control. J Hosp Infect 1998; 38:119.
  22. Haddy RI, Lee M 3rd, Sangal SP, et al. Klebsiella pneumoniae bacteremia in the community hospital. J Fam Pract 1989; 28:686.
  23. Lin SH, Kuo PH, Hsueh PR, et al. Sputum bacteriology in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease in Taiwan with an emphasis on Klebsiella pneumoniae and Pseudomonas aeruginosa. Respirology 2007; 12:81.
  24. Yi ZM, Yang H, Xiang XD. [Characteristics of bacteriology and drug sensitivity in patients with COPD combined with pneumonia]. Hunan Yi Ke Da Xue Xue Bao 2003; 28:272.
  25. Habib AG, Tambyah PA. Community-acquired Klebsiella pneumoniae central nervous system infections in adults in Singapore. Eur J Clin Microbiol Infect Dis 2003; 22:486.
  26. Yang PY, Huang CC, Leu HS, et al. Klebsiella pneumoniae bacteremia: community-acquired vs. nosocomial infections. Chang Gung Med J 2001; 24:688.
  27. Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection. Am J Med 1991; 91:72S.
  28. Yu VL, Hansen DS, Ko WC, et al. Virulence characteristics of Klebsiella and clinical manifestations of K. pneumoniae bloodstream infections. Emerg Infect Dis 2007; 13:986.
  29. Yu WL, Ko WC, Cheng KC, et al. Association between rmpA and magA genes and clinical syndromes caused by Klebsiella pneumoniae in Taiwan. Clin Infect Dis 2006; 42:1351.
  30. Yinnon AM, Butnaru A, Raveh D, et al. Klebsiella bacteraemia: community versus nosocomial infection. QJM 1996; 89:933.
  31. Kollef MH, Shorr A, Tabak YP, et al. Epidemiology and outcomes of health-care-associated pneumonia: results from a large US database of culture-positive pneumonia. Chest 2005; 128:3854.
  32. Weber DJ, Rutala WA, Sickbert-Bennett EE, et al. Microbiology of ventilator-associated pneumonia compared with that of hospital-acquired pneumonia. Infect Control Hosp Epidemiol 2007; 28:825.
  33. Kollef MH, Morrow LE, Niederman MS, et al. Clinical characteristics and treatment patterns among patients with ventilator-associated pneumonia. Chest 2006; 129:1210.
  34. Okada F, Ando Y, Honda K, et al. Clinical and pulmonary thin-section CT findings in acute Klebsiella pneumoniae pneumonia. Eur Radiol 2009; 19:809.
  35. Okada F, Ando Y, Honda K, et al. Acute Klebsiella pneumoniae pneumonia alone and with concurrent infection: comparison of clinical and thin-section CT findings. Br J Radiol 2010; 83:854.
  36. Mandell LA, Wunderink RG, Anzueto A, et al. Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis 2007; 44 Suppl 2:S27.
  37. van der Eerden MM, Vlaspolder F, de Graaff CS, et al. Value of intensive diagnostic microbiological investigation in low- and high-risk patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis 2005; 24:241.
  38. Hu HC, Huang CC, Tsai YH, et al. Outcome analysis of patients requiring mechanical ventilation with severe community-acquired pneumonia and identified bacterial pathogens. Chang Gung Med J 2005; 28:229.
  39. Marik PE. The clinical features of severe community-acquired pneumonia presenting as septic shock. Norasept II Study Investigators. J Crit Care 2000; 15:85.
  40. Paganin F, Lilienthal F, Bourdin A, et al. Severe community-acquired pneumonia: assessment of microbial aetiology as mortality factor. Eur Respir J 2004; 24:779.
  41. Fiberesima FP, Onwuchekwa AC. Community acquired pneumonia in Port Harcourt Rivers State of Nigeria. Cent Afr J Med 2008; 54:1.
  42. Lin YT, Wang YP, Wang FD, Fung CP. Community-onset Klebsiella pneumoniae pneumonia in Taiwan: clinical features of the disease and associated microbiological characteristics of isolates from pneumonia and nasopharynx. Front Microbiol 2015; 9:122.
  43. Lin YT, Jeng YY, Chen TL, Fung CP. Bacteremic community-acquired pneumonia due to Klebsiella pneumoniae: clinical and microbiological characteristics in Taiwan, 2001-2008. BMC Infect Dis 2010; 10:307.
  44. Jong GM, Hsiue TR, Chen CR, et al. Rapidly fatal outcome of bacteremic Klebsiella pneumoniae pneumonia in alcoholics. Chest 1995; 107:214.
  45. Li XJ, Li Q, Si LY, Yuan QY. Bacteriological differences between COPD exacerbation and community-acquired pneumonia. Respir Care 2011; 56:1818.
  46. Rosell A, Monsó E, Soler N, et al. Microbiologic determinants of exacerbation in chronic obstructive pulmonary disease. Arch Intern Med 2005; 165:891.
  47. Nseir S, Cavestri B, Di Pompeo C, et al. Factors predicting bacterial involvement in severe acute exacerbations of chronic obstructive pulmonary disease. Respiration 2008; 76:253.
  48. Wang JL, Chen KY, Fang CT, et al. Changing bacteriology of adult community-acquired lung abscess in Taiwan: Klebsiella pneumoniae versus anaerobes. Clin Infect Dis 2005; 40:915.
  49. Takayanagi N, Kagiyama N, Ishiguro T, et al. Etiology and outcome of community-acquired lung abscess. Respiration 2010; 80:98.
  50. Bartlett JG. The role of anaerobic bacteria in lung abscess. Clin Infect Dis 2005; 40:923.
  51. Cheng KC, Lee MF, Chuang YC, Yu WL. First description of lung abscess caused by ST23 clone capsule genotype K1 Klebsiella pneumoniae. J Formos Med Assoc 2015; 114:379.
  52. Yu VL, Chang FY. The role of Klebsiella pneumoniae in lung abscesses: a geographic phenomenon (for now!). Clin Infect Dis 2006; 42:152.
  53. Wang JH, Liu YC, Lee SS, et al. Primary liver abscess due to Klebsiella pneumoniae in Taiwan. Clin Infect Dis 1998; 26:1434.
  54. Cheng DL, Liu YC, Yen MY, et al. Septic metastatic lesions of pyogenic liver abscess. Their association with Klebsiella pneumoniae bacteremia in diabetic patients. Arch Intern Med 1991; 151:1557.
  55. Nadasy KA, Domiati-Saad R, Tribble MA. Invasive Klebsiella pneumoniae syndrome in North America. Clin Infect Dis 2007; 45:e25.
  56. Wang TK, Wong SS, Woo PC. Two cases of pyomyositis caused by Klebsiella pneumoniae and review of the literature. Eur J Clin Microbiol Infect Dis 2001; 20:576.
  57. Brook I, Frazier EH. Aerobic and anaerobic microbiology of empyema. A retrospective review in two military hospitals. Chest 1993; 103:1502.
  58. Chen KY, Hsueh PR, Liaw YS, et al. A 10-year experience with bacteriology of acute thoracic empyema: emphasis on Klebsiella pneumoniae in patients with diabetes mellitus. Chest 2000; 117:1685.
  59. Lin YT, Chen TL, Siu LK, et al. Clinical and microbiological characteristics of community-acquired thoracic empyema or complicated parapneumonic effusion caused by Klebsiella pneumoniae in Taiwan. Eur J Clin Microbiol Infect Dis 2010; 29:1003.
  60. Gaynes R, Edwards JR, National Nosocomial Infections Surveillance System. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005; 41:848.
  61. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32:470.
  62. Luzzaro F, Viganò EF, Fossati D, et al. Prevalence and drug susceptibility of pathogens causing bloodstream infections in northern Italy: a two-year study in 16 hospitals. Eur J Clin Microbiol Infect Dis 2002; 21:849.
  63. Friedman ND, Kaye KS, Stout JE, et al. Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002; 137:791.
  64. Meatherall BL, Gregson D, Ross T, et al. Incidence, risk factors, and outcomes of Klebsiella pneumoniae bacteremia. Am J Med 2009; 122:866.
  65. Chetcuti Zammit S, Azzopardi N, Sant J. Mortality risk score for Klebsiella pneumoniae bacteraemia. Eur J Intern Med 2014; 25:571.
  66. Tumbarello M, Spanu T, Sanguinetti M, et al. Bloodstream infections caused by extended-spectrum-beta-lactamase-producing Klebsiella pneumoniae: risk factors, molecular epidemiology, and clinical outcome. Antimicrob Agents Chemother 2006; 50:498.
  67. Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39:309.
  68. Fowler VG Jr, Miro JM, Hoen B, et al. Staphylococcus aureus endocarditis: a consequence of medical progress. JAMA 2005; 293:3012.
  69. Anderson MJ, Janoff EN. Klebsiella endocarditis: report of two cases and review. Clin Infect Dis 1998; 26:468.
  70. Hsu CN, Wang JY, Tseng CD, et al. Clinical features and predictors for mortality in patients with infective endocarditis at a university hospital in Taiwan from 1995 to 2003. Epidemiol Infect 2006; 134:589.
  71. Gould K, Ramirez-Ronda CH, Holmes RK, Sanford JP. Adherence of bacteria to heart valves in vitro. J Clin Invest 1975; 56:1364.
  72. Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clin Infect Dis 2007; 45:273.
  73. Echols RM, Tosiello RL, Haverstock DC, Tice AD. Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis. Clin Infect Dis 1999; 29:113.
  74. Lorente Garín JA, Placer Santos J, Salvadó Costa M, et al. [Antibiotic resistance transformation in community-acquired urinary infections]. Rev Clin Esp 2005; 205:259.
  75. Grupper M, Kravtsov A, Potasman I. Emphysematous cystitis: illustrative case report and review of the literature. Medicine (Baltimore) 2007; 86:47.
  76. Huang JJ, Tseng CC. Emphysematous pyelonephritis: clinicoradiological classification, management, prognosis, and pathogenesis. Arch Intern Med 2000; 160:797.
  77. Chang SW, Yen DH, Fung CP, et al. Klebsiella pneumoniae renal abscess. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:721.
  78. Takebayashi K, Matsumoto S, Nakagawa Y, et al. Endogenous endophthalmitis and disseminated intravascular coagulation complicating a Klebsiella pneumoniae perirenal abscess in a patient with type 2 diabetes. Am J Med Sci 2005; 329:157.
  79. Stotka JL, Rupp ME. Klebsiella pneumoniae urinary tract infection complicated by endophthalmitis, perinephric abscess, and ecthyma gangrenosum. South Med J 1991; 84:790.
  80. Skerk V, Krhen I, Schonwald S, et al. The role of unusual pathogens in prostatitis syndrome. Int J Antimicrob Agents 2004; 24 Suppl 1:S53.
  81. Krieger JN, McGonagle LA. Diagnostic considerations and interpretation of microbiological findings for evaluation of chronic prostatitis. J Clin Microbiol 1989; 27:2240.
  82. Liu KH, Lee HC, Chuang YC, et al. Prostatic abscess in southern Taiwan: another invasive infection caused predominantly by Klebsiella pneumoniae. J Microbiol Immunol Infect 2003; 36:31.
  83. Kuo PH, Huang KH, Lee CW, et al. Emphysematous prostatitis caused by Klebsiella pneumoniae. J Formos Med Assoc 2007; 106:74.
  84. Tai HC. Emphysematous prostatic abscess: a case report and review of literature. J Infect 2007; 54:e51.
  85. Bae GB, Kim SW, Shin BC, et al. Emphysematous prostatic abscess due to Klebsiella pneumoniae: report of a case and review of the literature. J Korean Med Sci 2003; 18:758.
  86. Ebisuno S, Miyai M. A case of Klebsiella pneumoniae endophthalmitis metastasized from prostatitis. Hinyokika Kiyo 1994; 40:625.
  87. Chuang LH, Song HS, Lee SC, et al. Endogenous Klebsiella pneumoniae endophthalmitis associated with prostate abscess: case report. Chang Gung Med J 2000; 23:240.
  88. Chew LC. Septic monoarthritis and osteomyelitis in an elderly man following Klebsiella pneumoniae genitourinary infection: case report. Ann Acad Med Singapore 2006; 35:100.
  89. Rahimian J, Wilson T, Oram V, Holzman RS. Pyogenic liver abscess: recent trends in etiology and mortality. Clin Infect Dis 2004; 39:1654.
  90. Lederman ER, Crum NF. Pyogenic liver abscess with a focus on Klebsiella pneumoniae as a primary pathogen: an emerging disease with unique clinical characteristics. Am J Gastroenterol 2005; 100:322.
  91. Fung CP, Chang FY, Lee SC, et al. A global emerging disease of Klebsiella pneumoniae liver abscess: is serotype K1 an important factor for complicated endophthalmitis? Gut 2002; 50:420.
  92. Frazee BW, Hansen S, Lambert L. Invasive infection with hypermucoviscous Klebsiella pneumoniae: multiple cases presenting to a single emergency department in the United States. Ann Emerg Med 2009; 53:639.
  93. Brook I, Frazier EH. Microbiology of liver and spleen abscesses. J Med Microbiol 1998; 47:1075.
  94. Lee CH, Leu HS, Hu TH, Liu JW. Splenic abscess in southern Taiwan. J Microbiol Immunol Infect 2004; 37:39.
  95. Lee CH, Hu TH, Liu JW. Splenic abscess caused by Klebsiella pneumoniae and non-Klebsiella pneumoniae in Taiwan: emphasizing risk factors for acquisition of Klebsiella pneumoniae splenic abscess. Scand J Infect Dis 2005; 37:905.
  96. Chang KC, Chuah SK, Changchien CS, et al. Clinical characteristics and prognostic factors of splenic abscess: a review of 67 cases in a single medical center of Taiwan. World J Gastroenterol 2006; 12:460.
  97. Such J, Runyon BA. Spontaneous bacterial peritonitis. Clin Infect Dis 1998; 27:669.
  98. Park YH, Lee HC, Song HG, et al. Recent increase in antibiotic-resistant microorganisms in patients with spontaneous bacterial peritonitis adversely affects the clinical outcome in Korea. J Gastroenterol Hepatol 2003; 18:927.
  99. Song JY, Jung SJ, Park CW, et al. Prognostic significance of infection acquisition sites in spontaneous bacterial peritonitis: nosocomial versus community acquired. J Korean Med Sci 2006; 21:666.
  100. Chen YJ, Kuo HK, Wu PC, et al. A 10-year comparison of endogenous endophthalmitis outcomes: an east Asian experience with Klebsiella pneumoniae infection. Retina 2004; 24:383.
  101. Tan YM, Chee SP, Soo KC, Chow P. Ocular manifestations and complications of pyogenic liver abscess. World J Surg 2004; 28:38.
  102. Wong JS, Chan TK, Lee HM, Chee SP. Endogenous bacterial endophthalmitis: an east Asian experience and a reappraisal of a severe ocular affliction. Ophthalmology 2000; 107:1483.
  103. Lin HH, Chien CC, Fang JT, et al. Unusual clinical presentation of Klebsiella pneumoniae induced endogenous endophthalmitis and xanthogranulomatous pyelonephritis in a non-nephrolithiasis and non-obstructive urinary tract. Ren Fail 2002; 24:659.
  104. Ang LP, Lee HM, Au Eong KG, et al. Endogenous Klebsiella endophthalmitis. Eye (Lond) 2000; 14:855.
  105. Ang M, Jap A, Chee SP. Prognostic factors and outcomes in endogenous Klebsiella pneumoniae endophthalmitis. Am J Ophthalmol 2011; 151:338.
  106. Yoon YH, Lee SU, Sohn JH, Lee SE. Result of early vitrectomy for endogenous Klebsiella pneumoniae endophthalmitis. Retina 2003; 23:366.
  107. Durand ML, Calderwood SB, Weber DJ, et al. Acute bacterial meningitis in adults. A review of 493 episodes. N Engl J Med 1993; 328:21.
  108. Korinek AM, Baugnon T, Golmard JL, et al. Risk factors for adult nosocomial meningitis after craniotomy: role of antibiotic prophylaxis. Neurosurgery 2006; 59:126.
  109. Tang LM, Chen ST. Klebsiella pneumoniae meningitis: prognostic factors. Scand J Infect Dis 1994; 26:95.
  110. van de Beek D, de Gans J, Spanjaard L, et al. Clinical features and prognostic factors in adults with bacterial meningitis. N Engl J Med 2004; 351:1849.
  111. Chang WN, Lu CH, Chang CS, Huang CR. Community-acquired spontaneous bacterial meningitis in patients with alcoholic liver disease. J Formos Med Assoc 2003; 102:653.
  112. Bouadma L, Schortgen F, Thomas R, et al. Adults with spontaneous aerobic Gram-negative bacillary meningitis admitted to the intensive care unit. Clin Microbiol Infect 2006; 12:287.
  113. Ni YH, Yeh KM, Peng MY, et al. Community-acquired brain abscess in Taiwan: etiology and probable source of infection. J Microbiol Immunol Infect 2004; 37:231.
  114. Fang CT, Chen YC, Chang SC, et al. Klebsiella pneumoniae meningitis: timing of antimicrobial therapy and prognosis. QJM 2000; 93:45.
  115. Chang CM, Lu FH, Guo HR, Ko WC. Klebsiella pneumoniae fascial space infections of the head and neck in Taiwan: emphasis on diabetic patients and repetitive infections. J Infect 2005; 50:34.
  116. Huang TT, Tseng FY, Yeh TH, et al. Factors affecting the bacteriology of deep neck infection: a retrospective study of 128 patients. Acta Otolaryngol 2006; 126:396.
  117. Jang TN, Juang GD, Fung CP. Fulminating gas-forming psoas muscle abscess due to Klebsiella pneumoniae following a deep neck infection. J Formos Med Assoc 1997; 96:134.
  118. Liu YM, Chi CY, Ho MW, et al. Microbiology and factors affecting mortality in necrotizing fasciitis. J Microbiol Immunol Infect 2005; 38:430.
  119. Ou LF, Yeh FL, Fang RH, Yu KW. Bacteriology of necrotizing fasciitis: a review of 58 cases. Zhonghua Yi Xue Za Zhi (Taipei) 1993; 51:271.
  120. Corredoira JM, Ariza J, Pallarés R, et al. Gram-negative bacillary cellulitis in patients with hepatic cirrhosis. Eur J Clin Microbiol Infect Dis 1994; 13:19.
  121. Cheng NC, Yu YC, Tai HC, et al. Recent trend of necrotizing fasciitis in Taiwan: focus on monomicrobial Klebsiella pneumoniae necrotizing fasciitis. Clin Infect Dis 2012; 55:930.
  122. DiGioia RA, Kane JG, Parker RH. Crepitant cellulitis and myonecrosis caused by Klebsiella. JAMA 1977; 237:2097.
  123. Bruno-Murtha LA, Sedghivaziri MA, Arbeit RD. Crepitant myonecrosis caused by Klebsiella pneumoniae in an immunocompromised diabetic patient. J Infect Dis 1990; 162:1415.
  124. Lau YJ, Hu BS, Wu WL, et al. Identification of a major cluster of Klebsiella pneumoniae isolates from patients with liver abscess in Taiwan. J Clin Microbiol 2000; 38:412.
  125. Chang CM, Ko WC, Lee HC, et al. Klebsiella pneumoniae psoas abscess: predominance in diabetic patients and grave prognosis in gas-forming cases. J Microbiol Immunol Infect 2001; 34:201.
  126. Chen CW, Ko WC, Sung JM, Huang JJ. Ruptured mycotic aneurysm of the iliac artery complicated by emphysematous psoas muscle abscess: report of two cases. J Formos Med Assoc 2002; 101:144.
  127. Sugawa M, Tanaka R, Nakamura M, et al. A case of infectious pseudoaneurysm of the abdominal aorta associated with infectious spondylitis due to Klebsiella pneumoniae. Jpn J Med 1989; 28:402.
  128. MacKinnon S, Kane JG, Parker RH. False-positive cryptococcal antigen test and cervical prevertebral abscess. JAMA 1978; 240:1982.
  129. Kouroussis C, Georgoulias V, Souglakos J, et al. Spontaneous spondylodiscitis caused by Klebsiella pneumoniae. Infection 1999; 27:368.
  130. Kangwanprasert M, Young RS. Case report: spinal epidural abscess from Klebsiella pneumoniae. Hawaii Med J 2005; 64:216.
  131. Kuramochi G, Takei SI, Sato M, et al. Klebsiella pneumoniae liver abscess associated with septic spinal epidural abscess. Hepatol Res 2005; 31:48.
  132. Broom MJ, Beebe RD. Emphysematous septic arthritis due to Klebsiella pneumoniae. Clin Orthop Relat Res 1988; :219.
  133. Ritter MS, Mroch H, Burns MJ. Soaring suppurative sea shells from the sea shore: Pseudomonas aeruginosa and Klebsiella pneumoniae septic arthritis after a marine sea shell injury. Pediatr Emerg Care 1993; 9:289.
  134. Park CH, Joo YE, Choi SK, et al. Klebsiella pneumoniae septic arthritis in a cirrhotic patient with hepatocellular carcinoma. J Korean Med Sci 2004; 19:608.
  135. Apple JS, Halvorsen RA, Chapman TM, Martinez S. Klebsiella pneumoniae arthritis of the hip in a diabetic patient. South Med J 1984; 77:229.
  136. Yu WL, Cheng CC, Chuang YC. First report of acute purulent pericarditis by capsule genotype K1 Klebsiella pneumoniae in an alcoholic patient. Diagn Microbiol Infect Dis 2009; 63:346.
  137. Hara N, Kato M, Fuse K, et al. A rare case of pyogenic liver abscess complicated with cardiac tamponade. Intern Med 2008; 47:563.
  138. Yahalom G, Guranda L, Meltzer E. Internal obturator muscle abscess caused by Klebsiella pneumoniae. J Infect 2007; 54:e157.
  139. Hsu PJ, Lee CH, Lee FY, Liu JW. Clinical and microbiological characteristics of mycotic aneurysms in a medical center in southern Taiwan. J Microbiol Immunol Infect 2008; 41:318.
  140. Chen YJ, Chen SY, Wang JT, Hsueh PR. Mycotic aneurysm caused by gas-forming serotype K5 Klebsiella pneumoniae. Int J Infect Dis 2009; 13:e47.
  141. Chuang YC, Lee MF, Yu WL. Mycotic aneurysm caused by hypermucoviscous Klebsiella pneumoniae serotype K54 with sequence type 29: an emerging threat. Infection 2013; 41:1041.
  142. Paterson DL, Ko WC, Von Gottberg A, et al. International prospective study of Klebsiella pneumoniae bacteremia: implications of extended-spectrum beta-lactamase production in nosocomial Infections. Ann Intern Med 2004; 140:26.
  143. Cartelle M, del Mar Tomas M, Pertega S, et al. Risk factors for colonization and infection in a hospital outbreak caused by a strain of Klebsiella pneumoniae with reduced susceptibility to expanded-spectrum cephalosporins. J Clin Microbiol 2004; 42:4242.
  144. DiPersio JR, Deshpande LM, Biedenbach DJ, et al. Evolution and dissemination of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: epidemiology and molecular report from the SENTRY Antimicrobial Surveillance Program (1997-2003). Diagn Microbiol Infect Dis 2005; 51:1.
  145. Wiener J, Quinn JP, Bradford PA, et al. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999; 281:517.
  146. Dinubile MJ, Friedland I, Chan CY, et al. Bowel colonization with resistant gram-negative bacilli after antimicrobial therapy of intra-abdominal infections: observations from two randomized comparative clinical trials of ertapenem therapy. Eur J Clin Microbiol Infect Dis 2005; 24:443.
  147. García San Miguel L, Cobo J, Valverde A, et al. Clinical variables associated with the isolation of Klebsiella pneumoniae expressing different extended-spectrum beta-lactamases. Clin Microbiol Infect 2007; 13:532.
  148. Herbert S, Halvorsen DS, Leong T, et al. Large outbreak of infection and colonization with gram-negative pathogens carrying the metallo- beta -lactamase gene blaIMP-4 at a 320-bed tertiary hospital in Australia. Infect Control Hosp Epidemiol 2007; 28:98.
  149. Nouér SA, Nucci M, de-Oliveira MP, et al. Risk factors for acquisition of multidrug-resistant Pseudomonas aeruginosa producing SPM metallo-beta-lactamase. Antimicrob Agents Chemother 2005; 49:3663.
  150. Schwaber MJ, Klarfeld-Lidji S, Navon-Venezia S, et al. Predictors of carbapenem-resistant Klebsiella pneumoniae acquisition among hospitalized adults and effect of acquisition on mortality. Antimicrob Agents Chemother 2008; 52:1028.
  151. Walsh TR, Toleman MA, Poirel L, Nordmann P. Metallo-beta-lactamases: the quiet before the storm? Clin Microbiol Rev 2005; 18:306.
  152. Hirakata Y, Izumikawa K, Yamaguchi T, et al. Rapid detection and evaluation of clinical characteristics of emerging multiple-drug-resistant gram-negative rods carrying the metallo-beta-lactamase gene blaIMP. Antimicrob Agents Chemother 1998; 42:2006.
  153. Bratu S, Tolaney P, Karumudi U, et al. Carbapenemase-producing Klebsiella pneumoniae in Brooklyn, NY: molecular epidemiology and in vitro activity of polymyxin B and other agents. J Antimicrob Chemother 2005; 56:128.
  154. Ruiz E, Ocampo-Sosa AA, Rezusta A, et al. Acquisition of carbapenem resistance in multiresistant Klebsiella pneumoniae strains harbouring blaCTX-M-15, qnrS1 and aac(6')-Ib-cr genes. J Med Microbiol 2012; 61:672.
  155. Kaczmarek FM, Dib-Hajj F, Shang W, Gootz TD. High-level carbapenem resistance in a Klebsiella pneumoniae clinical isolate is due to the combination of bla(ACT-1) beta-lactamase production, porin OmpK35/36 insertional inactivation, and down-regulation of the phosphate transport porin phoe. Antimicrob Agents Chemother 2006; 50:3396.
  156. Song W, Suh B, Choi JY, et al. In vivo selection of carbapenem-resistant Klebsiella pneumoniae by OmpK36 loss during meropenem treatment. Diagn Microbiol Infect Dis 2009; 65:447.
  157. Zarkotou O, Pournaras S, Tselioti P, et al. Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment. Clin Microbiol Infect 2011; 17:1798.
  158. Wu PF, Chuang C, Su CF, et al. High minimum inhibitory concentration of imipenem as a predictor of fatal outcome in patients with carbapenem non-susceptible Klebsiella pneumoniae. Sci Rep 2016; 6:32665.
  159. Li W, Sun G, Yu Y, et al. Increasing occurrence of antimicrobial-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in China. Clin Infect Dis 2014; 58:225.
  160. Lin YT, Pan YJ, Lin TL, et al. Transfer of CMY-2 Cephalosporinase from Escherichia coli to Virulent Klebsiella pneumoniae Causing a Recurrent Liver Abscess. Antimicrob Agents Chemother 2015; 59:5000.