Community-Acquired versus Nosocomial Klebsiella pneumoniae Bacteremia: Clinical Features, Treatment Outcomes, and Clinical Implication of Antimicrobial Resistance.
10.3346/jkms.2006.21.5.816
- Author:
Cheol In KANG
1
;
Sung Han KIM
;
Ji Whan BANG
;
Hong Bin KIM
;
Nam Joong KIM
;
Eui Chong KIM
;
Myoung Don OH
;
Kang Won CHOE
Author Information
1. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. mdohmd@snu.ac.kr
- Publication Type:Original Article ; Comparative Study
- Keywords:
Klebsiella pneumoniae;
Bacteremia;
Treatment Outcome;
Risk Factors;
Drug Resistance, Micro-bial
- MeSH:
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
- From:Journal of Korean Medical Science
2006;21(5):816-822
- CountryRepublic of Korea
- Language:English
-
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.
