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

• Published in: BMC infectious diseases Vol. 12; no. 1; p. 239
• Main Authors: 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
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 03.10.2012; BioMed Central; BMC
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Analysis; Antibiotics; Antimicrobial agents; Bacteremia; Bacteremia - epidemiology; Bacteremia - microbiology; Bacteremia - mortality; Bacteremia - pathology; Blood pressure; Community-acquired infections; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Community-Acquired Infections - mortality; Community-Acquired Infections - pathology; Community-onset infection; Comparative analysis; Cross infection; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - mortality; Cross Infection - pathology; Disease; Epidemiology; Female; Gram-negative bacteria; Health aspects; Healthcare-associated; Hospitals; Humans; Internal medicine; Klebsiella infections; Klebsiella Infections - epidemiology; Klebsiella Infections - microbiology; Klebsiella Infections - mortality; Klebsiella Infections - pathology; Klebsiella pneumoniae; Liver; Liver cirrhosis; Liver diseases; Male; Medicine; Middle Aged; Mortality; Nosocomial infections; Older people; Prognosis; Republic of Korea - epidemiology; Retrospective Studies; Risk Factors; South Korea; Survival Analysis; Tertiary Care Centers; Young Adult; Republic of Korea; South Korea; Korea
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/1471-2334-12-239

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). 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. 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. 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.