Differences in characteristics between healthcare-associated and community-acquired infection in community-onset Klebsiella pneumoniae bloodstream infection in Korea

Abstract

BackgroundHealthcare-associated (HCA) infection has emerged as a new epidemiological category. The aim of this study was to evaluate the impact of HCA infection on mortality in community-onset Klebsiella pneumoniae bloodstream infection (KpBSI).MethodsWe conducted a retrospective study in two tertiary-care hospitals over a 6-year period. All adult patients with KpBSI within 48 hours of admission were enrolled. We compared the clinical characteristics of HCA and community-acquired (CA) infection, and analyzed risk factors for mortality in patients with community-onset KpBSI.ResultsOf 553 patients with community-onset KpBSI, 313 (57%) were classified as HCA- KpBSI and 240 (43%) as CA-KpBSI. In patients with HCA-KpBSI, the severity of the underlying diseases was higher than in patients with CA-KpBSI. Overall the most common site of infection was the pancreatobiliary tract. Liver abscess was more common in CA-KpBSI, whereas peritonitis and primary bacteremia were more common in HCA-KpBSI. Isolates not susceptible to extended-spectrum cephalosporin were more common in HCA- KpBSI than in CA-KpBSI (9% [29/313] vs. 3% [8/240]; p = 0.006). Overall 30-day mortality rate was significantly higher in HCA-KpBSI than in CA-KpBSI (22% [70/313] vs. 11% [27/240]; p = 0.001). In multivariate analysis, high Charlson’s weighted index of co-morbidity, high Pitt bacteremia score, neutropenia, polymicrobial infection and inappropriate empirical antimicrobial therapy were significant risk factors for 30-day mortality.ConclusionsHCA-KpBSI in community-onset KpBSI has distinctive characteristics and has a poorer prognosis than CA-KpBSI, but HCA infection was not an independent risk factor for 30-day mortality.

Klebsiella variicola Is a Frequent Cause of Bloodstream Infection in the Stockholm Area, and Associated with Higher Mortality Compared to K. pneumoniae

“…Here we addressed for the first time to our knowledge, the possible presence of a link between phylogroup and bacterial traits (virulence factor, serotypes) or severity of disease. The overall 30-day mortality was 17.3%, similar to some of the previous studies on BSI caused by K. pneumoniae [7] – [10] . Analyzing phylogroups in relation to mortality, KpIII had the highest 30-day mortality (10/34, 29.4%).…”

“…Klebsiella pneumoniae is a gram-negative pathogen causing a wide spectrum of both hospital- and community-acquired infections such as urinary tract infection, pneumonia, intraabdominal infection, bloodstream infection (BSI), meningitis and pyogenic liver abscess (PLA) [1] – [6] . The mortality in invasive infection is high, ranging between 17.5 and 23% [7] – [10] .…”

Risk factors of mortality in bloodstream infections caused by Klebsiella pneumonia

“…The mortality rate in PBT patients in the present study was 34.6% compared with other studies in which PBT was rare (4–21%). [ 4 , 8 , 32 ]…”

Invasive infection caused by Klebsiella pneumoniae is a disease affecting patients with high comorbidity and associated with high long-term mortality

“…pneumoniae have been associated with comorbidities such as cancer, diabetes, and previous organ transplantation [ 7 , 8 ]. A high case fatality rate has been reported, ranging between 18 and 49%, where more recent studies focus on infections caused by multi-drug resistant isolates [ 3 , 7 , 9 – 13 ]. A population-based study on bloodstream infection (BSI) caused by K .…”