title: Clinical characteristics and outcome of patients with community-onset Klebsiella pneumoniae bacteremia requiring intensive care.
abstract: BACKGROUND
  Klebsiella pneumoniae (K. pneumoniae) is the major pathogen of community-acquired pyogenic infections in Taiwan and can lead to poor prognosis in critically ill patients complicated with bacteremia. This study investigated the characteristics and outcome of patients with community-onset K. pneumoniae bacteremia who required intensive care.
  
  
  METHODS
  Adult patients with community-onset K. pneumoniae bacteremia requiring intensive care were retrospectively analyzed, compared with those treated in ordinary wards, and determined for risk factors for infection-related mortality and long-term mortality at a medical center in Taiwan over a 3-year period.
  
  
  RESULTS
  Among the 309 patients with community-onset K. pneumoniae bacteremia, 58 patients (18.8%) required intensive care. Respiratory tract infection [Odds ratio (OR) = 3.67, 95% confidence interval (CI) = 1.79-7.50, p < 0.001] was the independent risk factor for ICU admission. Infection-related mortality was 34.5%. Higher APACHE II score (OR = 1.43; 95% CI = 1.02-2.01; p = 0.041) and underlying malignant neoplasm (OR = 35.48; 95% CI = 2.54-495.57; p = 0.008) were independent predictors of infection-related mortality on multivariate logistic regression. One-year overall mortality was 58.6% and malignant neoplasm was the predisposing factor for poor long-term outcome.
  
  
  CONCLUSIONS
  Nearly one fifth of patients with community-onset K. pneumoniae bacteremia required intensive care and this was associated with high mortality and poor long-term prognosis. Physicians should recognize the distinct characteristics and risk factors for mortality among these patients.
authors: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Chih-Peng
authors: CP
authors: Tseng
authors: Hau-Shin
authors: HS
authors: Wu
authors: Tung-Han
authors: TH
authors: Wu
authors: Yi-Tsung
authors: YT
authors: Lin
authors: Chang-Phone
authors: CP
authors: Fung
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016470:Bacteremia / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*; D003422:Critical Care / Q000379:methods; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality / Q000473:pathology*; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents