Klebsiella pneumoniae bacteremia: community-acquired vs. nosocomial infections.
BACKGROUND
This study attempted to determine the clinical manifestations and influential factors affecting the prognosis of patients with community-acquired and nosocomial bacteremia of Klebsiella pneumoniae (K. pneumoniae).


METHODS
We retrospectively reviewed the medical records of 211 patients who had a clinically significant episode of K. pneumoniae bacteremia from January 1997 until December 1999.


RESULTS
Most reports describe K. pneumoniae bacteremia as typically nosocomial, but in our study approximately 3 of 4 episodes were community-acquired. Without including "unknown origin", the most common infectious site for both community-acquired and nosocomial bacteremia was the hepatobiliary tract. The overall mortality for all 211 patients with K. pneumoniae bacteremia was 25.1%. Significantly higher mortality rates occurred in patients who were elderly (> 65 years), had a nosocomial infection, for whom the respiratory tract was the portal of entry, and ultimately fatal conditions or acute complications were due to shock or renal insufficiency.


CONCLUSIONS
Patients with community-acquired and nosocomial bacteremia had different types of underlying diseases. Isolates from nosocomial infections were significantly more frequently resistant to aminoglycosides, antipseudomonal penicillin, and all three generations of cephalosporins. In this regard, an aggressive empirical therapeutic approach to infections of K. pneumoniae is suggested.
Yang
P Y
PY
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, ROC.
Huang
C C
CC
Leu
H S
HS
Chiang
P C
PC
Wu
T L
TL
Tsao
T C
TC
D000328:Adult; D000367:Age Factors; D000368:Aged; D016470:Bacteremia / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D017714:Community-Acquired Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D003428:Cross Infection / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D012189:Retrospective Studies