Klebsiella pneumoniae fascial space infections of the head and neck in Taiwan: emphasis on diabetic patients and repetitive infections

Abstract

Objectives. To assess the epidemiological features, clinical characteristics, treatment, and outcome of head and neck infections caused by Klebsiella pneumoniae. Methods. We reviewed records of four common aerobic pathogens isolated by the microbiological laboratory of a teaching hospital in Taiwan from July 1995 to December 1999. Patients aged 14 or older with community-acquired fascial space infections of head and neck were identified by review of medical records and included in the study. Results. A total of 100 cases were identified, and K. pneumoniae was the most common pathogen of monomicrobial infections (48%), followed by viridans streptococci (15%). Polymicrobial infections were noted in 35 cases. In comparison with patients with infections not caused by K. pneumoniae, those with monomicrobial K. pneumoniae infections were older ( P=0.04) and had a higher prevalence of diabetes mellitus ( P<0.001), a longer duration of antimicrobial therapy ( P=0.007), a longer hospital stay ( P=0.001), and more repetitive infections ( P=0.001). All but one of K. pneumoniae isolates were susceptible to first generation cephalosporins and aminoglycosides. Conclusions. K. pneumoniae is an important endemic pathogen of fascial space infections of head and neck in Taiwan, especially among diabetics. Physicians should be aware of the tendency of this organism to cause repetitive infection.