title: Differences in characteristics between healthcare-associated and community-acquired infection in community-onset Klebsiella pneumoniae bloodstream infection in Korea.
abstract: BACKGROUND
  Healthcare-associated (HCA) infection has emerged as a new epidemiological category. The aim of this study was to evaluate the impact of HCA infection on mortality in community-onset Klebsiella pneumoniae bloodstream infection (KpBSI).
  
  
  METHODS
  We conducted a retrospective study in two tertiary-care hospitals over a 6-year period. All adult patients with KpBSI within 48 hours of admission were enrolled. We compared the clinical characteristics of HCA and community-acquired (CA) infection, and analyzed risk factors for mortality in patients with community-onset KpBSI.
  
  
  RESULTS
  Of 553 patients with community-onset KpBSI, 313 (57%) were classified as HCA- KpBSI and 240 (43%) as CA-KpBSI. In patients with HCA-KpBSI, the severity of the underlying diseases was higher than in patients with CA-KpBSI. Overall the most common site of infection was the pancreatobiliary tract. Liver abscess was more common in CA-KpBSI, whereas peritonitis and primary bacteremia were more common in HCA-KpBSI. Isolates not susceptible to extended-spectrum cephalosporin were more common in HCA- KpBSI than in CA-KpBSI (9% [29/313] vs. 3% [8/240]; p = 0.006). Overall 30-day mortality rate was significantly higher in HCA-KpBSI than in CA-KpBSI (22% [70/313] vs. 11% [27/240]; p = 0.001). In multivariate analysis, high Charlson's weighted index of co-morbidity, high Pitt bacteremia score, neutropenia, polymicrobial infection and inappropriate empirical antimicrobial therapy were significant risk factors for 30-day mortality.
  
  
  CONCLUSIONS
  HCA-KpBSI in community-onset KpBSI has distinctive characteristics and has a poorer prognosis than CA-KpBSI, but HCA infection was not an independent risk factor for 30-day mortality.
authors.affiliation: Department of Internal Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Seongnam 463-707, Republic of Korea.
authors.forename: Younghee
authors.initials: Y
authors.lastname: Jung
authors.forename: Myung Jin
authors.initials: MJ
authors.lastname: Lee
authors.forename: Hye-Yun
authors.initials: HY
authors.lastname: Sin
authors.forename: Nak-Hyun
authors.initials: NH
authors.lastname: Kim
authors.forename: Jeong-Hwan
authors.initials: JH
authors.lastname: Hwang
authors.forename: Jinyong
authors.initials: J
authors.lastname: Park
authors.forename: Pyoeng Gyun
authors.initials: PG
authors.lastname: Choe
authors.forename: Wan Beom
authors.initials: WB
authors.lastname: Park
authors.forename: Eu Suk
authors.initials: ES
authors.lastname: Kim
authors.forename: Sang-Won
authors.initials: SW
authors.lastname: Park
authors.forename: Kyoung Un
authors.initials: KU
authors.lastname: Park
authors.forename: Hong Bin
authors.initials: HB
authors.lastname: Kim
authors.forename: Nam-Joong
authors.initials: NJ
authors.lastname: Kim
authors.forename: Eui-Chong
authors.initials: EC
authors.lastname: Kim
authors.forename: Kyoung-Ho
authors.initials: KH
authors.lastname: Song
authors.forename: Myoung-Don
authors.initials: MD
authors.lastname: Oh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality* / Q000473:pathology; D017714:Community-Acquired Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality* / Q000473:pathology; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D062606:Tertiary Care Centers; D055815:Young Adult