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Abstract
Background
Although healthcare-associated (HCA) Klebsiella pneumoniae bacteremia constitutes a significant proportion of community-onset infection cases, its clinical and microbiologic characteristics have yet to be described in detail. In this study, we sought to delineate the clinical differences between community-associated (CA) and HCA K. pneumoniae bacteremia.
Materials and methods
A total of 240 patients infected by community-onset K. pneumoniae bacteremia were included in this study, and the data from the patients with HCA K. pneumoniae bacteremia were compared to those with the CA bacteremia. Isolates were microbiologically characterized and serotyped using a PCR method.
Results
Of the total 240 patients infected with community-onset K. pneumoniae bacteremia, 140 (58.3%) were defined as HCA infection cases, and the remaining 100 patients were classified as CA infections. Multivariate analysis showed that use of percutaneous tubes, occurrence of a recent surgical operation, cases of pneumonia, neutropenia and solid tumor, and prior receipt of antibiotics were all significant factors associated with HCA bacteremia infection (all P<0.05). In terms of microbiologic characteristics, ciprofloxacin resistance (12.9% [18/140] vs. 4.0% [4/100], P=0.02) and extended-spectrum β-lactamase production (12.1% [17/140] vs. 4.0% [4/100], P=0.03) were more common in HCA bacteremia than CA bacteremia, respectively. The K1 and K2 serotypes, which are considered virulent community strains, were observed to exist more frequently in CA bacteremia than in HCA bacteremia (34% [34/100] vs. 21.4% [30/140], P=0.03). The overall 30-day mortality of the study population was 17.5% (37/211), and there was a trend toward greater mortality in the HCA group than in the CA group (21.4% [27/126] vs. 11.8% [10/85]; P=0.07).
Conclusions
Patients infected with HCA bacteremia accounted for a substantial proportion of all patients with community-onset K. pneumoniae bacteremia, and showed significantly different clinical and microbiological characteristics than those infected with CA bacteremia. HCA K. pneumoniae bacteremia represented a distinct subset of community-onset bacteremia characterized by antibiotic resistant pathogens, a finding which physicians should consider in providing optimal treatment of these cases.
Figures and Tables
Table 1
Clinical Characteristics of Healthcare-associated Infections Versus Community-associated Infections in Community-onset Klebsiella pneumoniae Bacteremia
Data are presented as No.(%) of patients, unless otherwise indicated
CA, community-associated; HCA, healthcare-associated; SD, standard deviation
aSevere sepsis was defined as sepsis with one or more clinical signs of organ dysfunction.
bInappropriate initial antimicrobial therapy referred to the administration of antimicrobial agents to which the causative microorganisms were resistant, in vitro, or to the lack of an effective antimicrobial therapy for a known causative pathogen. In addition, the antimicrobial use was considered inappropriate if the antimicrobial agent was not administered within 24 h of bacteremia onset.
Table 2
Independent Factors Associated with Healthcare-associated Infections in Community-onset Klebsiella pneumoniae Bacteremia
Table 3
Microbiological Characteristics of Healthcare-associated Infections Versus Community-associated Infections in Community-onset Klebsiella pneumoniae Bacteremia
Table 4
Factors Associated with 30-day Mortality in Community-onset Klebsiella pneumoniae Bacteremia
Data are presented as No.(%) of patients, unless otherwise indicated.
IQR, interquartile range
aSevere sepsis was defined as sepsis with one or more clinical signs of organ dysfunction.
bInappropriate initial antimicrobial therapy referred to the administration of antimicrobial agents to which the causative microorganisms were resistant, in vitro, or to the lack of an effective antimicrobial therapy for a known causative pathogen. In addition, the antimicrobial use was considered inappropriate if the antimicrobial agent was not administered within 24 h of bacteremia onset.
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