title: Clinical and microbiological characteristics of community-acquired thoracic empyema or complicated parapneumonic effusion caused by Klebsiella pneumoniae in Taiwan.
abstract: Klebsiella pneumoniae is the major cause of community-acquired pyogenic infections in Taiwan and is becoming an increasing problem in acute thoracic empyema. This study evaluated the clinical and microbiological characteristics of community-acquired thoracic empyema or complicated parapneumonic effusion caused by K. pneumoniae in Taiwanese adults treated during the period 2001-2008 at a tertiary medical center. All clinical isolates were examined for capsular serotypes K1/K2, and pulsed-field gel electrophoresis (PFGE) was performed on strains of the same serotype. K. pneumoniae was the most frequent cause of community-acquired thoracic empyema or complicated parapneumonic effusion. It was associated with high mortality (32.4%) and was an independent risk factor for fatal outcome. Diabetes mellitus, liver cirrhosis, and bronchogenic carcinoma were independent risk factors for K. pneumoniae infection. Serotypes K1 (9/37, 24.3%) and K2 (13/37, 35.1%) were the prevalent strains but did not predispose patients to poor outcome compared with other non-K1/K2 serotypes. There was no major cluster of isolates found among serotype K1/K2 strains. In summary, physicians should be aware of the risk factors for thoracic empyema or complicated parapneumonic effusion caused by K. pneumoniae and the associated high mortality, and monitor these patients more closely.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201 Sec. 2 Shih-Pai Road 112, Taipei, Taiwan. ytlin8@vghtpe.gov.tw
authors.forename: Y-T
authors.initials: YT
authors.lastname: Lin
authors.forename: T-L
authors.initials: TL
authors.lastname: Chen
authors.forename: L K
authors.initials: LK
authors.lastname: Siu
authors.forename: S-F
authors.initials: SF
authors.lastname: Hsu
authors.forename: C-P
authors.initials: CP
authors.lastname: Fung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016000:Cluster Analysis; D017714:Community-Acquired Infections / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D016172:DNA Fingerprinting; D016521:Electrophoresis, Gel, Pulsed-Field; D016724:Empyema, Pleural / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D010996:Pleural Effusion / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality / Q000473:pathology*; D015995:Prevalence; D012307:Risk Factors; D012703:Serotyping; D013624:Taiwan / Q000453:epidemiology