Abstract
BackgroundKlebsiella pneumoniae bacteremia is a major cause of morbidity and mortality worldwide. We aimed to compare the clinical characteristics, distribution of capsular types, and antimicrobial resistance of K. pneumoniae bacteremia among community-acquired (CA), healthcare-associated (HCA), and nosocomial infections.MethodsThis retrospective study of patients with K. pneumoniae bacteremia was conducted at Taipei Veterans General Hospital from January to December 2015. Clinical characteristics of K. pneumoniae bacteremia were collected. The K. pneumoniae isolates were subjected to antimicrobial susceptibility testing and capsular genotyping.ResultsIn total, 337 patients with K. pneumoniae bacteremia were identified: 70 (20.8%), 102 (30.3%), and 165 (48.9%) presented with CA, HCA, and nosocomial infection, respectively. The 28-day mortality of HCA bacteremia was lower than that of nosocomial bacteremia (17.6% versus 30.9%, p = 0.016); however, that of the HCA and CA bacteremia was similar (17.6% versus 14.3%, p = 0.557). CA isolates had the highest prevalence of virulent capsular types (51.4%), followed by HCA (36.3%) and nosocomial isolates (19.4%). The proportion of multidrug-resistant (MDR) isolates was highest in nosocomial infections (41.8%), followed by HCA (23.5%) and CA infections (5.7%).ConclusionCA, HCA and nosocomial K. pneumoniae are distinct entities, as evidenced by the differences in clinical characteristics, antimicrobial resistance, and capsular types found in this study.
Highlights
Klebsiella pneumoniae bacteremia is a major cause of morbidity and mortality worldwide
The capsular type K1 isolates were more common in community-onset infection than in nosocomial infection, whereas non-typeable isolates were more common in nosocomial infection than in community-onset infection in a previous study conducted in Taiwan [4]. rmpA, a regulator of the mucoid phenotype, and a gene known as an extracapsular polysaccharide synthesis regulator, can positively control the mucoid phenotype of K. pneumoniae, and it is considered as an important virulence factor [11]
CA K. pneumoniae bacteremia is defined as K. pneumoniae-positive isolates identified in patients upon admission or within 48 h of admission who did not fit the criteria for HCA bacteremia
Summary
We aimed to compare the clinical characteristics, distribution of capsular types, and antimicrobial resistance of K. pneumoniae bacteremia among community-acquired (CA), healthcare-associated (HCA), and nosocomial infections. Klebsiella pneumoniae bacteremia is a major cause of morbidity and mortality worldwide [1]. Capsular types K1 and K2 are the most frequently observed virulent types and are usually associated with community-onset pyogenic infections in Asian countries [9]. Other capsular types, such as K5, K20, K54, and K57, were recently identified in individuals with community-onset pyogenic K. pneumoniae infections in Asian countries [10]. The capsular type K1 isolates were more common in community-onset infection than in nosocomial infection, whereas non-typeable isolates were more common in nosocomial infection than in community-onset infection in a previous study conducted in Taiwan [4]. rmpA, a regulator of the mucoid phenotype, and a gene known as an extracapsular polysaccharide synthesis regulator, can positively control the mucoid phenotype of K. pneumoniae, and it is considered as an important virulence factor [11]
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