Uncovering the Challenges of Multidrug-Resistant Klebsiella Infections

We are continuing our new series, Media Day, where we spotlight individual medical institutions and infectious disease (ID) programs. This episode is with the Center for Discovery and Innovation (CDI), which is part of Hackensack Meridian.

One of the ongoing mysteries is why multidrug-resistant Klebsiella is spreading in high-risk patients in the hospital setting, and also causing urinary tract infections (UTIs) in elderly women in the community setting. Multidrug-resistant Klebsiella UTIs are a serious concern, with the Centers for Disease Control and Prevention (CDC) warning of a significant increase in antibiotic resistance, particularly against carbapenems.¹

“What we didn't appreciate, and still don't really appreciate, is how much of those drug resistant Klebsiella spill over into the community…We do know that lots of patients who leave the hospital end up bringing drug-resistant Klebsiella with them,” said Barry Kreiswirth, PhD, director, Kreiswirth Lab, Center for Discovery and Innovation. His team has been studying how much of this problem is in the community, and they have been working with partners in the community and hospitals to get isolates.

“The frightening observation that we've been making is that unfortunately, the community does seem to mirror what we're seeing in the hospital, with the unfortunate problem that we don't have the drugs to treat the Klebsiella in the community, like we do in the hospital,” Kreiswirth said. “And what I mean by that is most people, especially elderly women, who have urinary tract infections, are commonly given oral antibiotics. They're giving an antibiotic for 7-10 days. They take it orally, and hopefully that solves their problem. When they have drug resistant strains, those oral antibiotics don't work, and they have to actually get an injectable like we do in the hospital, and that really complicates the whole clinical process.”

What makes resistance difficult is not only the vertical evolution, but the transference to not only different strains of the same pathogen but to different pathogens altogether.

“We have drug resistant strains that spread from person to person, and that's called vertical evolution, meaning you're spreading an already drug-resistant strain…but in the back end, or underpinning that the resistance itself is carried on what's called mobile elements, or plasmids. And what these plasmids do is they can actually move from strain to strain, and not only from Klebsiella to Klebsiella, but from Klebsiella to E coli, and they carry drug resistance,” Kreiswirth said. “So by definition, a multidrug resistant plasmid not only carries antibiotic resistance to one drug, but to multiple drugs. So we've actually realized, and have observed, that in some cases, these drug resistant Klebsiellas literally are resistant to not 1, 2 or 3, but as many as 10 antibiotics, including the repertoire of oral drugs that we commonly use, which really makes these strains untreatable with oral drugs.”

In the next episode, Kreiswirth discusses preventative measures such as vacccines against Klebsiella and some of the difficulties of developing them.

Reference
1. About Carbapenem-resistant Enterobacterales. CDC. April 11, 2024. Accessed October 10, 2025. https://www.cdc.gov/klebsiella/about/index.html