Loss of renal function may render
hemodialysis patients more susceptible to
infectious diseases, which is the second of all-causes mortality in this population. In addition to
infection caused by the classic Klebsiella pneumoniae (cKp), however,
hemodialysis staffs are now facing new challenge with growing prevalence of the
carbapenem-resistant Kp (CR-Kp) and hypervirulent Kp (hvKp) as they are respectively associated with increased drug-resistance and virulence. We therefore chose to share our recent experience in treating severe
infections either caused (cKp, CR-Kp, hvKp) or complicated (CR-hvKp) by these strains in
hemodialysis patients. Based upon yet beyond published works, we further came up with the detection of intracranial lesion, novel diagnostic approach using unique
biomarkers followed by selection of appropriate
antibiotics, management of metastasic
abscesses and bracing for the most lethal scenario in the order of cKp, CR-Kp, hvKp and CR-hvKp, respectively. Since reports of complicated hvKp
infection in
hemodialysis patients were rare, we also discussed in details this clinical entity focusing on its epidemiology, mechanism of increased virulence and involvement of the
arteriovenous fistula as insidious source of persistent
septicemia. By covering the full spectrum of clinically relevant Kp stains specifically from the viewpoint of nephrology, our work had highlighted the importance of infection control in uremic state and vice versa. As such, it may greatly raise the awareness of dialysis staffs against the challenge of evolving Klebsiella pneumoniae
infection in
hemodialysis patients and expeditiously reach a higher degree of readiness which was proved to be the key determinant of ultimate survival.