Abstract
BackgroundHealthcare-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).MethodsWe 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.ResultsOf 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.ConclusionsHCA-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.
Highlights
Healthcare-associated (HCA) infection has emerged as a new epidemiological category
Within the last decade, the concept of healthcareassociated (HCA) infection has been introduced, and HCA infection has been described as an epidemiological category different from both community-acquired (CA) and nosocomial infection [1,2]
Klebsiella pneumoniae bloodstream infection (KpBSI) was classified into CA and nosocomial infections depending on bacteremia onset time: within 48 hours and after 48 hours of admission, respectively, and the different characteristics of CA-KpBSI versus nosocomial KpBSI have been well evaluated [11,14,15,17,18]
Summary
The aim of this study was to evaluate the impact of HCA infection on mortality in community-onset Klebsiella pneumoniae bloodstream infection (KpBSI). For gram-negative bacteria, the data on the impact of HCA infection on mortality were conflicting, as well [9,10,11,12]. Klebsiella pneumoniae is one of the most important gram-negative bacteria clinically, and K. pneumoniae bloodstream infection (KpBSI) has a mortality rate of about 20% [11,14,15,16].
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