J Korean Med Sci.  2006 Oct;21(5):816-822. 10.3346/jkms.2006.21.5.816.

Community-Acquired versus Nosocomial Klebsiella pneumoniae Bacteremia: Clinical Features, Treatment Outcomes, and Clinical Implication of Antimicrobial Resistance

• Kang CI
• Kim SH
• Bang JW
• Kim HB
• Kim NJ
• Kim EC
• Oh MD
• Choe KW

• KMID: 1781898
• DOI: http://doi.org/10.3346/jkms.2006.21.5.816

Abstract

We conducted this study to compare clinical features, outcomes, and clinical implication of antimicrobial resistance in Klebsiella pneumoniae bacteremia acquired as community vs. nosocomial infection. A total of 377 patients with K. pneumoniae bacteremia (191 community-acquired and 186 nosocomial) were retrospectively analyzed. Neoplastic diseases (hematologic malignancy and solid tumor, 56%) were the most commonly associated conditions in patients with nosocomial bacteremia, whereas chronic liver disease (35%) and diabetes mellitus (20%) were the most commonly associated conditions in patients with community-acquired bacteremia. Bacteremic liver abscess occurred almost exclusively in patients with community-acquired infection. The overall 30-day mortality was 24% (91/377), and the mortality of nosocomial bacteremia was significantly higher than that of community-acquired bacteremia (32% vs. 16%, p<0.001). Of all community-acquired and nosocomial isolates, 4% and 33%, respectively, were extended-spectrum cephalosporin (ESC)-resistant, and 4% and 21%, respectively, were ciprofloxacin (CIP)-resistant. In nosocomial infections, prior uses of ESC and CIP were found to be independent risk factors for ESC and CIP resistance, respectively. Significant differences were identified between community-acquired and nosocomial K. pneumoniae bacteremia, and the mortality of nosocomial infections was more than twice than that of community-acquired infections. Antimicrobial resistance was a widespread nosocomial problem and also identified in community-acquired infections.

Keyword

Klebsiella pneumoniae; Bacteremia; Treatment Outcome; Risk Factors; Drug Resistance, Micro-bial

MeSH Terms

Treatment Outcome
Risk Factors
Retrospective Studies
Middle Aged
Male
*Klebsiella pneumoniae
Klebsiella Infections/*drug therapy
Humans
Female
Drug Resistance, Bacterial
Cross Infection/*drug therapy/mortality
Community-Acquired Infections/*drug therapy/mortality
Ciprofloxacin/therapeutic use
Cephalosporins/therapeutic use
Bacteremia/*drug therapy/mortality
Aged, 80 and over
Aged
Adult
Adolescent
APACHE

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