Community-acquired Klebsiella pneumoniae pneumonia in ICU: a multicenter retrospective study

• Published in: Annals of intensive care Vol. 14; no. 1; p. 69
• Main Authors: Grosjean, Vincent, Gressens, Simon B., Pham, Tài, Gaudry, Stéphane, Ait-Oufella, Hafid, De Prost, Nicolas, Mayaux, Julien, Guerot, Emmanuel, Leflon-Guibout, Véronique, Mayer, Noémie, Bert, Frédéric, Gault, Nathalie, Massonnaud, Clément R., Roux, Damien
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 30.04.2024; Springer Nature B.V; SpringerOpen
• Subjects: Alcoholism; Anesthesiology; Bacterial pneumonia; Clinical outcomes; Community-acquired pneumonia; Critical Care Medicine; Emergency Medicine; Epidemiology; Health risks; Human health and pathology; Hypermuscoviscosity; Infectious diseases; Intensive; Intensive care; Klebsiella pneumoniae; Life Sciences; Medicine; Medicine & Public Health; Mortality; Multiple organ dysfunction syndrome; Prognosis; Pulmonology and respiratory tract; Santé publique et épidémiologie; Streptococcus infections; Streptococcus pneumoniae; Hypermuscoviscosity; Prognosis; Community-acquired pneumonia; Bacterial pneumonia; Virulence; Klebsiella pneumoniae; Streptococcus pneumoniae
• ISSN: 2110-5820; 2110-5820
• DOI: 10.1186/s13613-024-01269-3

Background Alongside the recent worldwide expansion of hypervirulent Klebsiella pneumoniae (KP) infections, the available literature regarding cases of community acquired pneumonias (KP-CAP) remains scarce but reports a strikingly high and early mortality. We performed a retrospective multicenter study (7 ICU in France) between 2015 and 2019, comparing prognosis and severity of KP-CAP versus Streptococcus pneumoniae - CAP (SP-CAP). Methods For each KP-CAP, three SP-CAP admitted in ICUs within the same center and within the same 6-month window were selected. When available, KP strains were studied, and bacterial virulence was genetically assessed for virulence factors. The primary outcome was in-hospital mortality. Associations between clinical outcomes and type of infection were tested using univariate and multivariate logistic regressions, adjusted for pairing variables. Results Twenty-seven KP-CAP and 81 SP-CAP were included. Respective in-hospital mortality rates were 59% ( n  = 16) and 17% ( n  = 14, p  < 0.001), despite adequate antibiotic therapy. KP-CAP median time from admission to death was 26.9 h [IQR 5.75–44 h] and were significantly associated with higher rates of multiple organ failures (93% vs. 42%, p  < 0.001), disseminated intravascular coagulation (12% vs. 1.3%, p  = 0.046), septic shock (median lactate on ICU admission 4.60 vs. 2.90 mmol/L, p  = 0.030) and kidney failure (KDIGO-3: 87% vs. 44%, p  < 0.001). Interestingly, alcoholism was the only identified predisposing factor of KP-CAP. Severity on ICU admission (2-fold higher for KP-CAP) was the only factor associated with mortality in a multivariate analysis. Conclusion We described a strong association between KP-CAP infection and higher and earlier mortality when compared to SP-CAP. Moreover, alcoholism was the sole predisposing factor associated with KP-CAP infection. These findings should raise awareness of clinicians involved in the management of severe CAP about this microbiological etiology. Future prospective studies are needed to confirm these results and to design strategies to improve the prognosis of such infections.