Differences in characteristics between healthcare-associated and community-acquired infection in community-onset Klebsiella pneumoniae bloodstream infection in Korea

作者：Jung Younghee; Lee Myung Jin; Sin Hye Yun; Kim Nak Hyun; Hwang Jeong Hwan; Park Jinyong; Choe Pyoeng Gyun; Park Wan Beom; Kim Eu Suk; Park Sang Won; Park Kyoung Un; Kim Hong Bin; Kim Nam Joong; Kim Eui Chong; Song Kyoung Ho^*; Oh Myoung Don

来源：BMC Infectious Diseases, 2012, 12: 239.

DOI：10.1186/1471-2334-12-239

• Klebsiella pneumoniae
• Bacteremia
• Community-acquired infections
• Healthcare-associated
• Community-onset infection
• Epidemiology

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.

• 出版日期2012-10-3