Occult Klebsiella pneumoniae bacteremia at emergency department: A single center experience

Chang, Eileen Kevyn; Kao, Kai-Liang; Tsai, Mao‐Song; Yang, Chia‐Jui; Huang, Yu-Tsung; Liu, Chia-Ying; Liao, Chun-Hsing

doi:10.1016/j.jmii.2015.08.010

Cited by 13 publications

(11 citation statements)

References 17 publications

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“…We observed that the crude annual incidence of PLA and KP-PLA increased significantly from 1994–2004 to 2004–2015, which could be due to larger number of inpatients and improved early diagnostic techniques. In short, PLA and KP-PLA are common health problems in mainland China, which consistent with the recent epidemiological trends observed in other countries and regions6121319202122232425.…”

Section: Discussionsupporting

confidence: 87%

A retrospective study of pyogenic liver abscess focusing on Klebsiella pneumoniae as a primary pathogen in China from 1994 to 2015

Qian

Wong

Lai

et al. 2016

Sci Rep

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Pyogenic liver abscess (PLA) is a common intra-abdominal infection in adults. In this study, we aim to explore demographic and clinical characteristics of PLA focusing on Klebsiella pneumoniae (K. pneumoniae) induced PLA (KP-PLA) in mainland China. A retrospective review of medical records from all patients with KP-PLA admitted to a tertiary teaching hospital over a 21-year period (1994–2015) was performed. Among 296 PLA cases with confirmed culture-positive data, K. pneumoniae was revealed as the predominant pathogen (n = 189, 63.9%), followed by Escherichia coli (n = 39, 13.2%). Strikingly, KP-PLA patients had a higher incidence of metabolic disorders, such as diabetes mellitus (49.7% vs. 36.4%, P = 0.027; odds ratio (OR): 1.725; 95% confidence interval (CI): 1.061–2.805), hypertension (38.1% vs. 19.6%, P = 0.001; OR: 2.520; 95% CI: 1.439–4.413), and fatty liver (32.3% vs. 14.0%, P = 0.001; OR: 2.923; 95% CI: 1.564–5.462) than those with non-K. pneumoniae induced PLA (non-KP-PLA). Moreover, patients with KP-PLA had higher susceptibility to septic metastatic infection at distant sites compared to those with non-KP-PLA (10.6% vs. 3.7%, p = 0.038). Our results indicate that K. pneumoniae is the predominant pathogen of PLA in mainland China. KP-PLA is frequently diagnosed in patients with metabolic diseases and has a higher risk for septic metastatic infection.

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Section: Discussionsupporting

confidence: 87%

A retrospective study of pyogenic liver abscess focusing on Klebsiella pneumoniae as a primary pathogen in China from 1994 to 2015

Qian

Wong

Lai

et al. 2016

Sci Rep

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“…Klebsiella pneumoniae (KP) is a pathogen commonly causing nosocomial infection, which is the culprit of hospital-acquired infections including pneumoniae, bloodstream infection, urinary tract infection, and hepatic abscess, especially among immunocompromised people. [ 1 2 3 ] The usage of carbapenems is increasing dramatically in Chinese hospitals. Carbapenem-resistant KP (CRKP) is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP (CSKP) isolates.…”

Section: Introductionmentioning

confidence: 99%

Risk Factors for Carbapenem-resistant Klebsiella pneumoniae Infection and Mortality of Klebsiella pneumoniae Infection

Wang

Qin

Huang

et al. 2018

Chinese Medical Journal

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Background:Klebsiella pneumoniae (KP) is a pathogen commonly causing nosocomial infection. Carbapenem-resistant KP (CRKP) is more resistant to multiple antimicrobial drugs than carbapenem-susceptible KP (CSKP) isolates. The aim of the present study was to identify the risk factors for CRKP infection and the predictors of mortality among KP-infected adult patients.Methods:Patients with CRKP and CSKP infection were categorized as the case group and control group, respectively, and we conducted a 1:1 ratio case-control study on these groups. The CRKP isolates collected were tested for antimicrobial susceptibility and presence of KP carbapenemase (KPC) gene. Clinical data were collected to identify risk factors for CRKP infection and mortality of KP infection. Risk factors were analyzed under univariable and multivariable logistic regression model.Results:The independent risk factors for CRKP infection were admission to Intensive Care Unit (odds ratio [OR]: 15.486, 95% confidence interval [CI]: 3.175–75.541, P < 0.001); use of β-lactams and β-lactamase inhibitor combination (OR: 4.765, 95% CI: 1.508–15.055, P = 0.008); use of cephalosporins (OR: 8.033, 95% CI: 1.623–39.763, P = 0.011); fluoroquinolones (OR: 6.090, 95% CI: 1.343–27.613, P = 0.019); and indwelling of urethral catheter (OR: 6.164, 95% CI: 1.847–20.578, P = 0.003). However, older age (OR: 1.079, 95% CI: 1.005–1.158, P = 0.036), Charlson comorbidity index (OR: 4.690, 95% CI: 2.094–10.504, P = 0.000), and aminoglycoside use (OR: 670.252, 95% CI: 6.577–68,307.730, P = 0.006) were identified as independent risk factors for patient deaths with KP infection. The mortality of CRKP group was higher than that of the CSKP group. KPC gene did not play a role in the CRKP group. CRKP mortality was high.Conclusion:Implementation of infection control measures and protection of the immunefunction are crucial.

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“…The focus can be obscure in patients presenting with light febrile disorder alone and no other major complaints. [ 11 ] However, considering the global background of antibiotics abuse, [ 12 ] K pneumoniae— an opportunistic pathogenic bacteria—can give rise to severe occult intracranial infection in an unexpected way. [ 13 ] The CSF culture result may explain the rapid progression of disease course and unfortunate result of this patient.…”

Section: Discussionmentioning

confidence: 99%

Occult community acquired Klebsiella pneumoniae purulent meningitis in an adult

Yang

Shrestha²,

Kolakshyapati

et al. 2018

Medicine

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Rationale:Klebsiella pneumonia (K. pneumonia), primarily a hospital-acquired pathogen, can cause a variety of deep-seated infections with significant morbidities. However, in the current scenario of global rise in antibiotic abuse, unexpected infection could be caused by K. pneumoniae.Patient concerns:A 56-year-old male who presented with intermittent headache and low fever was admitted, he had transsphenoidal surgery for pituitary adenoma 3 years ago. Routine laboratory tests revealed an elevated WBC count of 10.12 × 109/L and C-reactive protein (CRP) 12.9 mg/L. computed tomography (CT) revealed the sellar region with suspicious hemorrhage.Diagnoses:The patient was initially diagnosed with acute residual tumor hemorrhage. But the consequent diagnose of Klebsiella pneumoniae purulent meningitis was made based on the cerebrospinal fluid lab test and cerebrospinal fluid (CSF) and blood culture, and CT scan.Interventions:Lumbar puncture examination was made and the antibiotics were adjusted to meropenem and vancomycin according to the antibiotic sensitivity test. But because of the patient's unstable vital signs, his family refuse further lateral ventricular drainage.Outcomes:The infection was out of control and the patient died of spontaneous breath and heartbeat arrest.Lessons:Through this case, we could learn that any clue of suspicious intracranial infection should be carefully considered in the current scenario of global rise in antibiotic abuse. The manifestation of intermittent headache and mild fever could be potential signs of fatal infection, and prompt appropriate measures should be taken timely.

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Occult Klebsiella pneumoniae bacteremia at emergency department: A single center experience

Abstract: Most patients with occult KPB had favorable outcomes, but about half of them required a second ED visit. Clinicians should aggressively follow patients with occult KPB and should seek to identify the focus of infection in this endemic area.

Cited by 13 publications

References 17 publications

A retrospective study of pyogenic liver abscess focusing on Klebsiella pneumoniae as a primary pathogen in China from 1994 to 2015

A retrospective study of pyogenic liver abscess focusing on Klebsiella pneumoniae as a primary pathogen in China from 1994 to 2015

Risk Factors for Carbapenem-resistant Klebsiella pneumoniae Infection and Mortality of Klebsiella pneumoniae Infection

Occult community acquired Klebsiella pneumoniae purulent meningitis in an adult

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