title: Community-acquired Klebsiella pneumoniae complicated skin and soft-tissue infections of extremities: emphasis on cirrhotic patients and gas formation.
abstract: BACKGROUND
  Klebsiella pneumoniae was rarely reported to cause complicated skin and soft tissue infections (cSSTIs). Our study was to delineate clinical characteristics and outcome of cSSTIs involving extremities caused by K. pneumoniae.
  
  
  METHODS
  Adult patients aged 16 years or more with community-acquired cSSTIs, which involved the extremities and were caused by four common aerobic pathogens at a medical center in southern Taiwan during a 54-month period, were reviewed.
  
  
  RESULTS
  Of 76 cases enrolled, Staphylococcus aureus was the most common pathogen (52 cases, 68%), followed by K. pneumoniae (16, 21%), beta-hemolytic streptococci (5, 7%), and Escherichia coli (3, 4%). Forty-six (61%) had underlying conditions, and diabetes mellitus was most common among K. pneumoniae and non-K. pneumoniae groups (63% and 45%, respectively). Compared to patients with cSSTIs caused by other bacteria, those with K. pneumoniae cSSTIs were predominantly male, more often had liver cirrhosis, malignant neoplasm and alcoholism. In addition, they were more likely to have fever, shock, bacteremia, gas formation, pyomyositis, metastatic infections, as well as longer durations of hospitalization. Using multivariate analysis, liver cirrhosis (adjusted odds ratio [aOR] 12.5, 95% confidence interval [CI] 2.0-79.1, p = 0.007) and male gender (aOR 11.5, 95% CI 1.1-116.8, p = 0.039) were significantly associated with K. pneumoniae cSSTIs.
  
  
  CONCLUSIONS
  We highlight the role of K. pneumoniae in Taiwanese patients with cSSTIs involving extremities, and its potential for gas and pus formation, and metastatic infections. Empiric antimicrobial coverage of K. pneumoniae and close monitoring of metastatic infections are mandatory for patients with risk factors.
authors.affiliation: Division of Infectious Diseases, Dept. of Internal Medicine, National Cheng Kung University Hospital, #138 Sheng Li Road, Tainan, 70403, Taiwan.
authors.forename: C-M
authors.initials: CM
authors.lastname: Chang
authors.forename: H-C
authors.initials: HC
authors.lastname: Lee
authors.forename: N-Y
authors.initials: NY
authors.lastname: Lee
authors.forename: I-W
authors.initials: IW
authors.lastname: Lee
authors.forename: C-J
authors.initials: CJ
authors.lastname: Wu
authors.forename: P-L
authors.initials: PL
authors.lastname: Chen
authors.forename: C-C
authors.initials: CC
authors.lastname: Lee
authors.forename: N-Y
authors.initials: NY
authors.lastname: Ko
authors.forename: W-C
authors.initials: WC
authors.lastname: Ko
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D017714:Community-Acquired Infections; D005121:Extremities / Q000000981:diagnostic imaging / Q000382:microbiology*; D005260:Female; D005740:Gases; D006801:Humans; D007710:Klebsiella Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification / Q000502:physiology*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D012871:Skin Diseases / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology*; D018461:Soft Tissue Infections / Q000150:complications / Q000453:epidemiology / Q000382:microbiology / Q000503:physiopathology*; D013624:Taiwan / Q000453:epidemiology
chemical_list: D005740:Gases