Characteristics of Klebsiella pneumoniae bacteremia in community-acquired and nosocomial infections in diabetic patients.
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.
Tsai
Sung-Sheng
SS
Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Huang
Jui-Chu
JC
Chen
Szu-Tah
ST
Sun
Jui-Hung
JH
Wang
Chih-Ching
CC
Lin
Shu-Fu
SF
Hsu
Brend Ray-Sea
BR
Lin
Jen-Der
JD
Huang
Shu-Yu
SY
Huang
Yu-Yao
YY
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