990. Clinical Significance of Healthcare-Associated Infections in Community-Onset Klebsiella pneumoniae Bacteremia
Session: Poster Abstract Session: Clinical Studies of Bacterial Infection
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Among the patients with community-onset Klebsiella pneumoniae bacteremia (CO-KpB), clinical characteristics of healthcare-associated (HCA) infection and its impact on outcome have not been well evaluated.

Methods:We conducted a retrospective cohort study in two university-affiliated hospitals. From Jan. 2003 to Dec. 2008, all adult patients with K. pneumoniae bacteremia within 48 hours after admission were enrolled.

Results:Of 513 patients with CO-KpB, 294 (57%) were classified as HCA infection and 219 (43%) as community-acquired (CA) infection. In HCA-KpB, severity of underlying diseases was higher and primary bacteremia and peritonitis were more common than in CA-KpB. The overall 30-day mortality rate was significantly higher in HCA-KpB than in CA-KpB. In multivariate analyses, high Charlson comorbidity index, high Pitt bacteremia score, neutopenia at presentation, polymicrobial infection, and inappropriate choice of initial antibiotics were found to be significant risk factors for mortality.

Conclusion:HCA-KpB had distinctive characteristics in CO-KpB and showed higher mortality rates than CA-KpB. However, HCA infection itself was not an independent risk factor for mortality.

  

Table 1 Clinical characteristics of patients with community-onset Klebsiella pneumoniae bacteremia and significant risk factors for 30-day mortality

Different clinical characteristics

         

CA-KpB

(n = 219)

HCA-KpB

(n = 294)

P value

Underlying disease

 

 

 

  Diabetes mellitus

68 (31)

68 (23)

  0.044

  Chronic liver disease

35 (16)

75 (26)

  0.009

  Solid tumor

50 (23)

            165 (56)

               <0.001

Charlson WIC(≥3)

40 (18)

            127 (43)

<0.001

Source of infection

 

 

 

  Liver

  64 (29.2)

39 (13)

<0.001

  Peritoneum

             10 (5)

41 (14)

<0.001

Abscess formation

             81 (37)

63 (21)

<0.001

30-day mortality

             24 (11)

59 (20)

   0.006

Significant risk factors for mortality

No. of survivor

(n = 430)

No. of non-survivor

(n = 83)

Multivariate odds ratio

(95% CI )

  Charlson WIC (≥3)

125 (29)

42 (51)

2.7 (1.5-4.8)

  Polymicrobial infection

 52 (12)

19 (23)

2.8 (1.3-5.9)

  Neutropenia at presentation

25 (6)

20 (24)

2.8 (1.3-6.2)

  Pitt bacteremia score(≥4)

 44 (10)

44 (53)

11.7 (6.3-21.8)

  Inappropriate initial antibiotics                    

25 (6)

11 (13)

2.6 (1.0-6.6)

Data are no. (%) of patients. CI, confidence interval; WIC, weighted index of comorbidity.


Subject Category: J. Clinical practice issues

Younghee Jung, Hye-Yun Sin, Nak-Hyun Kim, MD, Jeong-Hwan Hwang, MD, Jinyong Park, MD, Kyoung-Ho Song, MD, Pyoeng Gyun Choe, MD, Wan Beom Park, MD, PhD, Eu Suk Kim, MD, PhD, Sang-Won Park, MD, Hong Bin Kim, MD, PhD, Nam-Joong Kim, MD and Myoung-don Oh, MD, PhD, Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea

Disclosures:

Y. Jung, None

H. Y. Sin, None

N. H. Kim, None

J. H. Hwang, None

J. Park, None

K. H. Song, None

P. G. Choe, None

W. B. Park, None

E. S. Kim, None

S. W. Park, None

H. B. Kim, None

N. J. Kim, None

M. D. Oh, None

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