title: Characteristics of Klebsiella pneumoniae bacteremia in community-acquired and nosocomial infections in diabetic patients.
abstract: BACKGROUND
  Although diabetes mellitus is known as a major risk factor for Klebsiella pneumoniae infection, the differences in clinical characteristics between community-acquired and nosocomial K. pneumoniae bacteremia in diabetic patients have been rarely reported.
  
  
  METHODS
  This retrospective analysis enrolled 193 adult diabetic patients with K. pneumoniae bacteremia hospitalized between January 2005 and December 2006. The chi-squared test, analysis of variance (ANOVA), Student's t test, Fisher exact test, and Cox regression model were used for statistical analysis.
  
  
  RESULTS
  Of the enrolled patients, 147 had community-acquired infections and 46 had nosocomial infections. Compared with the community group, the nosocomial group had higher rates of in-hospital mortality (41.3% vs. 18.4%, p=0.001), malignancy (50.0% vs. 19.0%, p<0.001), and leukopenia (21.7% vs. 5.4%, p=0.001) but had lower levels of serum C-reactive protein (124.3 mg/L vs. 188.7 mg/L, p=0.018) and HbA1c (8.1% vs. 9.5%, p=0.025). The rate of infection with the extended-spectrum β-lactamase-producing strain (ESBL infection) in the nosocomial group was 11 times higher than that in the community group (45.7% vs. 4.1%, p<0.001). ESBL infection accounted for 53% of mortality in the nosocomial group. Pneumonia was more common in the nosocomial group, while local abscess was more common in the community group. The risk factors for mortality were pneumonia, leukopenia, cirrhosis, and a high serum creatinine ratio (creatinine level at admission/baseline).
  
  
  CONCLUSIONS
  The nosocomial group had more ESBL infections which might account for the higher mortality. The HbA1c level during the course of infection did not affect the outcome. Pneumonia, leukopenia, cirrhosis, and a high serum creatinine ratio at admission were the risk factors for poor outcome.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Sung-Sheng
authors.initials: SS
authors.lastname: Tsai
authors.forename: Jui-Chu
authors.initials: JC
authors.lastname: Huang
authors.forename: Szu-Tah
authors.initials: ST
authors.lastname: Chen
authors.forename: Jui-Hung
authors.initials: JH
authors.lastname: Sun
authors.forename: Chih-Ching
authors.initials: CC
authors.lastname: Wang
authors.forename: Shu-Fu
authors.initials: SF
authors.lastname: Lin
authors.forename: Brend Ray-Sea
authors.initials: BR
authors.lastname: Hsu
authors.forename: Jen-Der
authors.initials: JD
authors.lastname: Lin
authors.forename: Shu-Yu
authors.initials: SY
authors.lastname: Huang
authors.forename: Yu-Yao
authors.initials: YY
authors.lastname: Huang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia; D017714:Community-Acquired Infections / Q000382:microbiology* / Q000401:mortality; D003428:Cross Infection / Q000382:microbiology* / Q000401:mortality; D048909:Diabetes Complications / Q000382:microbiology*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007710:Klebsiella Infections / Q000209:etiology*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors