Abstract
BackgroundKlebsiella pneumoniae is the major cause of community-acquired pyogenic infections in Taiwan. This retrospective study evaluated the clinical and microbiological characteristics of bacteremic community-acquired pneumonia due to K. pneumoniae in Taiwanese adults.MethodsThe clinical characteristics of bacteremic community-acquired pneumonia (CAP) in adults due to K. pneumoniae were compared to those of adults with bacteremic CAP due to Streptococcus pneumoniae at a tertiary medical center in Taiwan from 2001-2008. Risk factors for mortality of bacteremic CAP due to K. pneumoniae were analyzed. All clinical isolates of K. pneumoniae were examined for capsular serotypes, hypermucoviscosity phenotype, aerobactin and rmpA gene.ResultsK. pneumoniae was the dominant cause of bacteremic CAP and was associated with a more fulminant course and a worse prognosis than bacteremic CAP due to Streptococcus pneumoniae. Initial presentation with septic shock and respiratory failure were independent risk factors for both early and total mortality. Serotype K1 and K2 comprised around half of all isolates. There were no significant differences in the clinical characteristics of patients with bacteremic CAP due to K1/K2 and non-K1/K2 isolates. Hypermucoviscosity phenotype as well as the aerobactin and rmpA genes were highly prevalent in the K. pneumoniae isolates.ConclusionsK. pneumoniae continued to be the dominant cause of bacteremic CAP in Taiwanese adults during 2001-2008. Initial presentation with septic shock and respiratory failure were independent risk factors for both early and total mortality from K. pneumoniae bacteremic CAP. Serotypes K1/K2 comprised around half of all isolates, but did not predispose patients to a poor clinical outcome. Physicians should be aware of the poor prognosis of any patient with bacteremic K. pneumoniae CAP and monitor these patients more closely.
Highlights
Klebsiella pneumoniae is the major cause of community-acquired pyogenic infections in Taiwan
Clinical characteristics of patients with bacteremic communityacquired pneumonia (CAP) due to K. pneumoniae During the study period, 95 patients with bacteremic CAP due to either K. pneumoniae or S. pneumoniae were identified from 148 consecutive patients with bacteremic CAP
All patients with bacteremic K. pneumoniae CAP received concordant antibiotic treatment according to the results of susceptibility testing
Summary
Klebsiella pneumoniae is the major cause of community-acquired pyogenic infections in Taiwan This retrospective study evaluated the clinical and microbiological characteristics of bacteremic community-acquired pneumonia due to K. pneumoniae in Taiwanese adults. Pneumonia accounted for 29% and 62% of all cases of community-acquired K. pneumoniae bacteremia in Taiwan and South Africa, respectively; only four cases of community-acquired bacteremic K. pneumoniae pneumonia were seen in the United States, Argentina, Europe, or Australia [10]. The present study compared the clinical characteristics of bacteremic CAP due to K. pneumoniae with the characteristics of bacteremic CAP due to Streptococcus pneumoniae and the virulence factors of invasive K pneumoniae isolates in a tertiary medical center over an 8-year period in Taiwan
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