title: Positive culture for Klebsiella pneumoniae in relevant sputum samples as a predictor of rapidly fatal outcome in septic patients at medical intensive care units.
abstract: Sixty-five patients with main diagnosis of sepsis, who were directly admitted to the emergency department (ED) and had fatal outcomes after transfer to the medical intensive care units (MICU), were included. Patients who died within 48 hours of MICU transfer were defined as having rapidly fatal outcomes (RFO). The following clinical variables, including diagnosis of infection source; results of blood, sputum, and urine cultures; management for sepsis in the ED and MICU and survival time, were analyzed. There were 30 (46%) patients with RFO. The median survival time in the RFO group was 22.6 hours in MICU. Klebsiella pneumoniae was the most common pathogen isolated from blood (7/65, 10.7%) and relevant sputum samples (7/45, 15.5% ). Multivariate analysis revealed that age, gender and positive sputum culture for K. pneumoniae (hazard ratio, 11.898, p < 0.001) were independently associated with RFO in septic patients. The median survival times for patients with positive and negative K. pneumoniae sputum culture were 17 hours and 66.8 hours (p < 0.001, by the log rank test), respectively. This study found that positive sputum culture of K. pneumoniae was an important independent predictive factor of RFO in septic patients admitted to the MICU.
authors.affiliation: Department of Internal Medicine, Department of Health, Taoyuan General Hospital, Taoyuan, Taiwan.
authors.forename: T-Y
authors.initials: TY
authors.lastname: Chuang
authors.forename: C-J
authors.initials: CJ
authors.lastname: Lin
authors.forename: T-C
authors.initials: TC
authors.lastname: Chou
authors.forename: H-H
authors.initials: HH
authors.lastname: Huang
authors.forename: S-W
authors.initials: SW
authors.lastname: Lee
authors.forename: P-R
authors.initials: PR
authors.lastname: Hsueh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001769:Blood / Q000382:microbiology; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000175:diagnosis* / Q000382:microbiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D018805:Sepsis / Q000175:diagnosis* / Q000382:microbiology* / Q000401:mortality; D013183:Sputum / Q000382:microbiology*; D016019:Survival Analysis; D013997:Time Factors; D014556:Urine / Q000382:microbiology