title: Can a routine follow-up blood culture be justified in Klebsiella pneumoniae bacteremia? A retrospective case-control study.
abstract: BACKGROUND
  The need for mandatory confirmation of negative conversion in Klebsiella pneumoniae bacteremia (KpB) has not been adequately addressed. We conducted a retrospective case-control study of adult patients with KpB over a 5-year period in two tertiary-care hospitals to determine the risk factors for persistent bacteremia and to reevaluate the necessity of follow-up blood culture in KpB.
  
  
  METHODS
  Persistent KpB is defined as the finding of K. pneumoniae in more than two separate blood-culture samples for longer than a two-day period in a single episode. The case- and control-groups were patients with persistent and non-persistent KpB, respectively, and they were matched 1-to-3 according to age and gender.
  
  
  RESULTS
  Among 1068 KpB episodes analyzed after excluding polymicrobial infection and repeated KpB, follow-up blood cultures were performed in 862 cases (80.7%), 62 of which (7.2%) were persistent. Independent risk factors for persistence were intra-abdominal infection, higher Charlson's comorbidity weighted index score, prior solid organ transplantation, and unfavorable treatment response, which was defined as positivity for at least two parameters among fever, leukocytosis, and no decrease of C-reactive protein on the second day after initial culture. A proposed scoring system using four variables, namely, intra-abdominal infection, nosocomial KpB, fever and lack of C-reactive protein decrease, the last two being assessed on the second day after the initial blood culture, showed that only 4.9% of the patients with no risk factors or with only intra-abdominal infection had persistent KpB.
  
  
  CONCLUSIONS
  Though persistent KpB is uncommon, follow-up blood culture was performed in as many as 80% of the cases in this study. A more careful clinical assessment is warranted to reduce the cost and patient inconvenience involved in follow-up blood culture.
authors.affiliation: Seoul National University College of Medicine, 103 Daehak-ro, Jongro-gu, Seoul, Republic of Korea 110-460.
authors.forename: Chang Kyung
authors.initials: CK
authors.lastname: Kang
authors.forename: Eu Suk
authors.initials: ES
authors.lastname: Kim
authors.forename: Kyoung-Ho
authors.initials: KH
authors.lastname: Song
authors.forename: Hong Bin
authors.initials: HB
authors.lastname: Kim
authors.forename: Taek Soo
authors.initials: TS
authors.lastname: Kim
authors.forename: Nak-Hyun
authors.initials: NH
authors.lastname: Kim
authors.forename: Chung-Jong
authors.initials: CJ
authors.lastname: Kim
authors.forename: Pyoeng Gyun
authors.initials: PG
authors.lastname: Choe
authors.forename: Ji-Hwan
authors.initials: JH
authors.lastname: Bang
authors.forename: Wan Beom
authors.initials: WB
authors.lastname: Park
authors.forename: Kyoung Un
authors.initials: KU
authors.lastname: Park
authors.forename: Sang Won
authors.initials: SW
authors.lastname: Park
authors.forename: Nam-Joong
authors.initials: NJ
authors.lastname: Kim
authors.forename: Eui-Chong
authors.initials: EC
authors.lastname: Kim
authors.forename: Myoung-Don
authors.initials: MD
authors.lastname: Oh
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007710:Klebsiella Infections / Q000097:blood / Q000175:diagnosis* / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
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