Epidemiology and Outcome of Klebsiella Species Bloodstream Infection: A Population-Based Study

Al-Hasan, Majdi N.; Lahr, Brian D.; Eckel‐Passow, Jeanette E.; Baddour, Larry M.

doi:10.4065/mcp.2009.0410

Cited by 36 publications

(41 citation statements)

References 24 publications

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“…This is similar to the incidence of 5.7 per 100,000 observed in Victoria, Canada, during 1998 to 2005 (5). In a study investigating Klebsiella species BSI from the United States (1998 to 2007), Al-Hasan and colleagues found overall incidence (including hospital-onset disease) rates of 15.4 per 100,000 for males and 9.4 per 100,000 for females (148). Among a cohort of 127 patients, 60 (47%) patients had community-acquired BSI (50 with Klebsiella pneumoniae, 9 with Klebsiella oxytoca, and 1 with Klebsiella ornithinolytica), and 53 (42%) had health care-associated BSI (46 with Klebsiella pneumoniae and 7 with Klebsiella oxytoca).…”

Section: Specific Etiologiessupporting

confidence: 63%

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

2014

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SUMMARY Bloodstream infection (BSI) is a major cause of infectious disease morbidity and mortality worldwide. While a positive blood culture is mandatory for establishment of the presence of a BSI, there are a number of determinants that must be considered for establishment of this entity. Community-onset BSIs are those that occur in outpatients or are first identified <48 h after admission to hospital, and they may be subclassified further as health care associated, when they occur in patients with significant prior health care exposure, or community associated, in other cases. The most common causes of community-onset BSI include Escherichia coli , Staphylococcus aureus , and Streptococcus pneumoniae . Antimicrobial-resistant organisms, including methicillin-resistant Staphylococcus aureus and extended-spectrum β-lactamase/metallo-β-lactamase/carbapenemase-producing Enterobacteriaceae , have emerged as important etiologies of community-onset BSI.

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Section: Specific Etiologiessupporting

confidence: 63%

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

2014

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“…The search revealed nine publications that reported differences between men and women with respect to incidence of BSI (Table 5, available online). [23][24][25][26][27][28][29][30][31] Controlling for a variety of covariates, three of the articles reported that men had significantly higher infection rates than women, and six reported no significant gender differences. Although the majority found no significant gender differences, the fact that all studies reporting significant differences found that males were at higher risk suggests a possible association.…”

Section: Discussionmentioning

confidence: 99%

“…The results for BSI are surprising, as previous findings suggest that 25-43 % of all BSIs originate from UTIs, which are more common in women than in men. [15][16][17] One possible explanation could stem from detection bias for UTIs, which might go undetected more often in men because they are thought to be less common (and thus looked for with less vigilance) and because men are less likely to have urinary catheters and thus urine cultures. 18 If UTIs are more likely to go undiagnosed and untreated in men, this could potentially lead to higher rates of BSI.…”

Section: Discussionmentioning

confidence: 99%

Gender Differences in Risk of Bloodstream and Surgical Site Infections

et al. 2013

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BACKGROUND:Identifying patients most at risk for hospital-and community-associated infections is one essential strategy for preventing infections. OBJECTIVE: To investigate whether rates of community-and healthcare-associated bloodstream and surgical site infections varied by patient gender in a large cohort after controlling for a wide variety of possible confounders. DESIGN: Retrospective cohort study. PARTICIPANTS: All patients discharged from January 1, 2006 through December 31, 2008 (133,756 adult discharges and 66,592 pediatric discharges) from a 650-bed tertiary care hospital, a 220-bed community hospital, and a 280-bed pediatric acute care hospital within a large, academic medical center in New York, NY. MAIN MEASURES: Data were collected retrospectively from various electronic sources shared by the hospitals and linked using patients' unique medical record numbers. Infections were identified using previously validated computerized algorithms. KEY RESULTS: Odds of community-associated bloodstream infections, healthcare-associated bloodstream infections, and surgical site infections were significantly lower for women than for men after controlling for present-on-admission patient characteristics and events during the hospital stay [odds ratios (95 % confidence intervals) were 0. 85 (0.77-0.93), 0.82 (0.74-0.91), and 0.78 (0.68-0.91), respectively]. Gender differences were greatest for older adolescents (12-17 years) and adults 18-49 years and least for young children (<12 years) and older adults (≥70 years). CONCLUSIONS: In this cohort, men were at higher risk for bloodstream and surgical site infections, possibly due to differences in propensity for skin colonization or other anatomical differences.

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“…Carbapenem-resistant K. pneumoniae (CRKP) infections may be associated with an increased rate of treatment failure and death [6], and the dramatic increase in the occurrence of CRKP worldwide aggravates this situation further [7]. Furthermore, older age, nosocomial infections, intensive care interventions, disease severity, and several comorbidities were reported to represent host factor contributing to the increased mortality rates of KP-BSI patients [3, 5, 8, 9]. Additionally, β-lactams were the first-line antibiotics selected for the treatment of KP-BSI patients, however, with the increase in the number of K. pneumoniae isolates producing extended-spectrum β-lactamase, the use of carbapenems increased as well.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of Klebsiella pneumoniae bloodstream infections in a teaching hospital: factors related to the carbapenem resistance and patient mortality

Tian

Tan

Yang

et al. 2016

Antimicrob Resist Infect Control

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BackgroundAlthough Klebsiella pneumoniae bloodstream infections (KP-BSIs) have recently attracted attention due to an alarming raise in morbidity and mortality, there have been few reports on the epidemiology of KP-BSIs in mainland China. We sought to describe the epidemiological, microbiological, and clinical characteristics of KP-BSIs, focusing on the risk factors of carbapenem resistance and patient mortality.MethodsA retrospective analysis of WHONET data of KP-BSI patients admitted to a teaching hospital in Shanghai, China, between January 1, 2011 and December 31, 2015 was performed, and the annual percentage of patients with carbapenem-resistant K. pneumoniae (CRKP) was determined. Risk factors related to the carbapenem resistance and patient mortality were analyzed using binary logistic regression model. The genetic relatedness of CRKP strains isolated from intensive care unit (ICU) patients was determined by pulsed-field gel electrophoresis (PFGE).ResultsA total of 293 incidences of KP-BSIs were identified in a 5-year period, 22.18% of these (65/293) were CRKP strains, and the proportion of CRKP-BSI in ICU was 59.62% (31/52), equaling the levels observed in the epidemic regions. A number of KP-BSIs (114), obtained from January 1, 2014, to December 31, 2015, were further investigated. Skin and soft tissue infection source (odds ratio [OR] 26.63, 95% confidence interval [CI] 4.8–146.8) and ICU-acquired infection (OR 5.82, 95% CI 2.0–17.2) was shown to be powerful risk factors leading to the development of CRKP-BSI. The crude 28-day mortality rates of KP-BSI and CRKP-BSI patients were 22.8% and 33.3%, respectively. Lung as the probable source of infection (OR 4.23, 95% CI 1.0–17.3), and high Sequential Organ Failure Assessment (SOFA) score (OR 1.40, 95% CI 1.2–1.6) were strong prognostic factors determining crude 28-day KP-BSI mortality rates. PFGE analysis demonstrated that 10/11 random CRKP isolates in ICU belonged to the same clonal type.ConclusionsDuring the study period, we observed a significant increase in the occurrence of CRKP infections among the identified KP-BSIs in our hospital and especially in ICU, and we demonstrated that carbapenem resistance is associated with the increased mortality of KP-BSI patients.

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Epidemiology and Outcome of Klebsiella Species Bloodstream Infection: A Population-Based Study

Cited by 36 publications

References 24 publications

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

Population-Based Epidemiology and Microbiology of Community-Onset Bloodstream Infections

Gender Differences in Risk of Bloodstream and Surgical Site Infections

Epidemiology of Klebsiella pneumoniae bloodstream infections in a teaching hospital: factors related to the carbapenem resistance and patient mortality

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