Klebsiella

And VIM2 is the one that's very specific to Pseudomonas.

It's actually, if I remember correctly, I think toxic to enterobacterioles like E. coli and Klebsiella.

And I learned this from a recent review article that Emily and I got to co-author with Aaron McCreary and some other experts in the field.

So maybe we can link that to the show notes somehow, because it's a compendium of everything you would need to know about metallobetalactamases.

Yeah, and I think the challenge is what keeps us excited about this field, right? The challenges are always changing.

If you go back to waves of ESBLs being introduced in the United States and then KPC and NDM seems to be the next wave in which we are encountered with clinical challenges, right? I think there's a few things about NDM specifically that I think are important to note that are certainly outstanding challenges, one of which is the diversity with which we see NDM in different organisms.

KPC was very specific to Klebsiella.

And in fact, there was like one single clone, ST258 Klebsiella, that became a predominant clone globally.

So it's in this age of understanding of the microbiome, we're starting to understand what's going on.

And it's clear that people who have auto-intoxication have an overabundance of Klebsiella.

That's a proteobacteria species and to a lesser degree other species like E. coli and other proteobacteria like serratia.

But they also even more commonly have fungal overgrowth.

But these people who have auto-intoxication have an overabundance of those proteobacteria species, as well as fungal species, probably both in most cases.

Now, some of these diagnoses have been made with stool sampling, suggesting a colonic source, but some of these diagnoses were made with upper endoscopy, and obtaining a duodenal aspirate that is getting the liquid in the duodenum, just after the stomach, so way up high in the small intestine.

And that has proven to be abundantly populated by Klebsiella, other proteobacteria, and fungal species.

So all arrows are pointing towards SIBO, small intestinal bacterial overgrowth, And SIFO, small intestinal fungal overgrowth, that is infestation of the small intestine by both bacteria and fungi that produces alcohol.

So the microbiome that's actually floating in the hospital ducts and in the air.

And that is this lactobacillus deficient Klebsiella rich.

And Klebsiella is dysbiotic.

So those infants acquire immediately a dysbiotic gut.

Welcome back again to another great episode.

Some countries in Latin America have a 50% rate of C-sections.

What happens in those infants is they actually acquire the hospital microbiome.

So the microbiome that's actually floating in the hospital ducts and in the air, and that is this lactobacillus deficient Klebsiella rich.

They found mixed inflammation in her lungs.

They found Klebsiella in both lungs and Staphylococcus in one of her lungs.

However, so what was determined on the autopsy? So there's different things that they do so SIDS is when you don't know at all why the baby died but not determined is there's stuff going on in her body but I don't but they don't know what exactly killed her so essentially on her paperwork it said undetermined I went and I spoke to five lawyers.

Five lawyers all said that I have a case.

So because of that, the classic organisms you're gonna expect are gonna be enteric gram-negative bacteria, right? Bacteria that live in the gut, things like E.

coli, things like Klebsiella.

But in this day and age, we're seeing increasing numbers of less common or non-enteric bacteria, gram-positive organisms, multi-drug-resistant organisms, especially if this is a nosocomial or healthcare-associated infection.

So we're going to get into that a little bit more, but most classically, you're going to be growing enteric organisms like E. coli or Klebsiella.

So when should we suspect SBP? Well, SBP can be obvious.

Someone can come in with peritonitis and sepsis or can be extremely subtle and quiet.

I'm thinking, okay, probably gram-negative bacteria in the colon that creates that LPS production, lipopolysaccharides.

So a lot of times we'll see kids with a lot of proteus, mirabilis or Klebsiella or Citrobac, these crazy really kind of toxic bacteria.

So we can treat that.

We see in the stool analysis, you could see if they're underproducing digestive enzymes or if they just have like frank inflammatory bowel, like indicated of like Crohn's disease, celiac disease, things like that.