BMC Infectious Diseases (Oct 2012)

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

  • Jung Younghee,
  • Lee Myung,
  • Sin Hye-Yun,
  • Kim Nak-Hyun,
  • Hwang Jeong-Hwan,
  • Park Jinyong,
  • Choe Pyoeng,
  • Park Wan,
  • Kim Eu,
  • Park Sang-Won,
  • Park Kyoung,
  • Kim Hong,
  • Kim Nam-Joong,
  • Kim Eui-Chong,
  • Song Kyoung-Ho,
  • Oh Myoung-don

DOI
https://doi.org/10.1186/1471-2334-12-239
Journal volume & issue
Vol. 12, no. 1
p. 239

Abstract

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Abstract 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.

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