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The first, Klebsiella variicola, was proposed for strains isolated from plants (banana, rice, sugar cane, and maize) and human clinical samples based on DNA-DNA hybridization, sequencing of six genes, and phenotypic properties. The inherent difficulties in identification and separation of Klebsiella (and Raoultella) species, both in the past and the present, have made interpretation of clinical and environmental epidemiologic data of the genera difficult. Most Klebsiella and Raoultella species can be isolated from diverse mammals, birds, reptiles, insects, and environmental sources. In nosocomial infections, catheterization is believed to be an important factor in the incidence and spread of strains. This chapter talks about laboratory identification that includes isolation, biochemical methods, biotyping and immunodiagnostics. As with other pathogenic bacteria, virulence in Klebsiella is both multifactorial and complex, and the virulence factors produced may vary depending upon the site of the infection. If agglutination is inhibited by D-mannose, the adhesins are classified as mannose-sensitive hemagglutinins (MSHA) or mannose resistant. In six antimicrobial resistance prevalence studies published between 2001 and 2004 from Europe and North America, ranges of susceptibility were as follows: ceftazidime, 92 to 95%; ceftriaxone, 96 to 98%; cefotaxime, 96%; cefepime, 97 to 98%; ciprofloxacin, 93 to 95%; piperacillin-tazobactam, 90 to 97%; imipenem, 98 to 100%; gentamicin, 95 to 96%; amikacin, 98 to 99%; and trimethoprimsulfamethoxazole (SXT), 88 to 90%.
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