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Volume 46, Number 3, June 2013

Clinical characteristics and outcome of patients with community-onset Klebsiella pneumoniae bacteremia requiring intensive care 


Chih-Peng Tseng, Hau-Shin Wu, Tung-Han Wu, Yi-Tsung Lin, Chang-Phone Fung


Received: September 9, 2011    Revised: April 30, 2012    Accepted: June 1, 2012   

 

Corresponding author:

Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
Institute of Clinical Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
Corresponding author. Division of Infectious Disease, Department of Medicine, Taipei Veterans General Hospital, Number 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan. 



 

Background and purpose: 

Klebsiella pneumoniae (K. pneumoniae) is the major pathogen of community-acquired pyogenic infections in Taiwan and can lead to poor prognosis in critically ill patients complicated with bacteremia. This study investigated the characteristics and outcome of patients with community-onset K. pneumoniae bacteremia who required intensive care. 



 

Methods:

Adult patients with community-onset K. pneumoniae bacteremia requiring intensive care were retrospectively analyzed, compared with those treated in ordinary wards, and determined for risk factors for infection-related mortality and long-term mortality at a medical center in Taiwan over a 3-year period. 



 

Results:

Among the 309 patients with community-onset K. pneumoniae bacteremia, 58 patients (18.8%) required intensive care. Respiratory tract infection [Odds ratio (OR) = 3.67, 95% confidence interval (CI) = 1.79–7.50, p < 0.001] was the independent risk factor for ICU admission. Infection-related mortality was 34.5%. Higher APACHE II score (OR = 1.43; 95% CI = 1.02–2.01; p = 0.041) and underlying malignant neoplasm (OR = 35.48; 95% CI = 2.54–495.57; p = 0.008) were independent predictors of infection-related mortality on multivariate logistic regression. One-year overall mortality was 58.6% and malignant neoplasm was the predisposing factor for poor long-term outcome. 



 

Conclusion:

Nearly one fifth of patients with community-onset K. pneumoniae bacteremia required intensive care and this was associated with high mortality and poor long-term prognosis. Physicians should recognize the distinct characteristics and risk factors for mortality among these patients. 



 

Key words:

Bacteremia, Intensive care, Klebsiella pneumoniae