Infective Endocarditis and Carbapenem-Resistant Klebsiella pneumoniae Infections

Infective endocarditis is a life-threatening infection of the heart’s endocardial surface, most often affecting the cardiac valves. While Gram-positive cocci such as staphylococci and streptococci remain the predominant pathogens, Gram-negative bacilli—including Klebsiella pneumoniae—have emerged as important causes, particularly in healthcare settings, prosthetic valves and immunocompromised patients. Klebsiella pneumoniae is a versatile pathogen capable of causing pneumonia, bloodstream infections, urinary tract infections and endocarditis. Of particular concern is the rise of carbapenem-resistant K. pneumoniae, which withstands last-resort carbapenem antibiotics through production of carbapenemase enzymes (for example KPC, NDM and OXA-48 types) and through porin mutations. Carbapenem-resistant strains exhibit high mortality rates, limited therapeutic options and rapid global dissemination via mobile resistance plasmids. Diagnostic challenges include subtle clinical presentation in elderly or comorbid patients and the need for echocardiography combined with targeted microbiological testing. Treatment requires a balance of antimicrobial efficacy, toxicity and the use of novel agents such as ceftazidime-avibactam, often in combination regimens. Prevention hinges on strict infection control, antimicrobial stewardship and surveillance of resistance trends.

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Infective Endocarditis and Carbapenem-Resistant Klebsiella pneumoniae Infections publication trend

The graph below shows the total number of articles in infective endocarditis and carbapenem-resistant klebsiella pneumoniae infections across all publications each year (not limited to Nature Index journals).

Technical terms

Infective endocarditis: colonisation of the heart’s endocardial surface, especially valves, by microorganisms leading to vegetation formation and systemic complications.

Carbapenem-resistant Klebsiella pneumoniae: K. pneumoniae strains that evade carbapenem antibiotics through acquired resistance mechanisms, notably carbapenemase enzymes.

Carbapenemase: an enzyme secreted by certain bacteria that hydrolyses carbapenem antibiotics, neutralising their activity.

Hypermucoviscous phenotype: a mucoid colony appearance of K. pneumoniae linked to an increased polysaccharide capsule and augmented virulence.

Ceftazidime-avibactam: a combination antimicrobial pairing a third-generation cephalosporin with a β-lactamase inhibitor, effective against many carbapenemase-producing Gram-negative bacteria.

References

1. An Unusual Case of Klebsiella pneumoniae Endocarditis. Cureus (2020).
2. Prosthetic Joint Infection from Carbapenemase‐Resistant Klebsiella pneumoniae Successfully Treated with Ceftazidime‐Avibactam. Case Reports in Infectious Diseases (2018).
3. A Fatal Bacteremia Caused by Hypermucousviscous KPC-2 Producing Extensively Drug-Resistant K64-ST11 Klebsiella pneumoniae in Brazil. Frontiers in Medicine (2018).