Community-acquired versus nosocomial Klebsiella pneumoniae bacteremia: clinical features, treatment outcomes, and clinical implication of antimicrobial resistance.
We conducted this study to compare clinical features, outcomes, and clinical implication of antimicrobial resistance in Klebsiella pneumoniae bacteremia acquired as community vs. nosocomial infection. A total of 377 patients with K. pneumoniae bacteremia (191 community-acquired and 186 nosocomial) were retrospectively analyzed. Neoplastic diseases (hematologic malignancy and solid tumor, 56%) were the most commonly associated conditions in patients with nosocomial bacteremia, whereas chronic liver disease (35%) and diabetes mellitus (20%) were the most commonly associated conditions in patients with community-acquired bacteremia. Bacteremic liver abscess occurred almost exclusively in patients with community-acquired infection. The overall 30-day mortality was 24% (91/377), and the mortality of nosocomial bacteremia was significantly higher than that of community-acquired bacteremia (32% vs. 16%, p<0.001). Of all community-acquired and nosocomial isolates, 4% and 33%, respectively, were extended-spectrum cephalosporin (ESC)-resistant, and 4% and 21%, respectively, were ciprofloxacin (CIP)-resistant. In nosocomial infections, prior uses of ESC and CIP were found to be independent risk factors for ESC and CIP resistance, respectively. Significant differences were identified between community-acquired and nosocomial K. pneumoniae bacteremia, and the mortality of nosocomial infections was more than twice than that of community-acquired infections. Antimicrobial resistance was a widespread nosocomial problem and also identified in community-acquired infections.
Kang
Cheol-In
CI
Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
Kim
Sung-Han
SH
Bang
Ji-Whan
JW
Kim
Hong-Bin
HB
Kim
Nam-Joong
NJ
Kim
Eui-Chong
EC
Oh
Myoung-don
MD
Choe
Kang-Won
KW
D018806:APACHE; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000188:drug therapy* / Q000401:mortality; D002511:Cephalosporins / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000401:mortality; D003428:Cross Infection / Q000188:drug therapy* / Q000401:mortality; D024881:Drug Resistance, Bacterial; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy*; D007711:Klebsiella pneumoniae; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D002511:Cephalosporins; D002939:Ciprofloxacin