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Characteristics of Bacteremia Between Community-Acquired and Nosocomial Klebsiella pneumoniae Infection
Risk Factor for Mortality and the Impact of Capsular Serotypes as a Herald for Community-Acquired Infection
Ren-Wen Tsay, MD;
L. K. Siu, PhD;
Chang-Phone Fung, MD;
Feng-Yee Chang, MD, PhD
Arch Intern Med. 2002;162:1021-1027.
Background Although several epidemiological surveys of Klebsiella clinical isolates have been performed, few studies have correlated
the clinical isolate with disease.
Objective To compare the clinical and bacteriological characteristics of Klebsiella pneumoniae bacteremia acquired as community
or nosocomial infections.
Methods We prospectively enrolled 158 consecutively hospitalized patients with K pneumoniae bacteremia. Clinical data were reviewed. Antimicrobial
susceptibility testing and capsular serotyping were performed. We used the  2 test, the Fisher exact test, or the t test
for statistic analysis.
Results Underlying diabetes mellitus was more common in community-acquired than
in nosocomial infection (46/94 [49%] vs 8/64 [12%]; P<.001).
On the other hand, neoplastic disease (34/64 [53%] vs 13/94 [14%]; P<.001) and antibiotic resistance (P<.01)
were more frequent in patients with nosocomial compared with community-acquired
infections. Klebsiella pneumoniae liver abscesses,
which were all community acquired, accounted for the source of 22 (23%) of
94 community-acquired K pneumoniae infections. No
attributable source of infection was found for 37 (58%) of the 64 nosocomial
infections vs 15 (16%) of the 94 community-acquired infections. Only 58 isolates
(36.7%) could be serotyped; of these, capsular serotypes K1, K2, and K28 accounted
for 37 (23.4%), 8 (5.1%), and 6 (3.8%), respectively, of all strains. However,
typeable isolates were significantly more common among community-acquired
than nosocomial isolates (42/94 [45%] vs 16/64 [25%]; P = .01), especially for serotype K1 (28/94 [30%] vs 9/64 [14%]; P = .02). Significant risk factors for mortality included
nosocomial infection, lung infection, thrombocytopenia, leukopenia, ceftazidime
resistance, inappropriate antimicrobial therapy, and septic shock.
Conclusions Significant differences were identified between community-acquired and
nosocomial K pneumoniae bacteremia. Ceftazidime resistance
in nosocomial K pneumoniae bacteremia carried a high
risk for mortality, and serotype K1 in K pneumoniae
was more prevalent in community-acquired infection, suggesting more virulence.
From the Division of Infectious Diseases and Tropical Medicine, Department
of Internal Medicine, Tri-Service General Hospital, National Defense Medical
Center (Drs Tsay and Chang), the Division of Clinical Research, National Health
Research Institute (Dr Siu), and the Division of Infectious Diseases, Department
of Medicine, Taipei Veterans General Hospital and National Yang-Ming University
(Dr Fung), Taipei, Taiwan. Dr Tsay is now with the Division of Infectious
Diseases, Department of Internal Medicine, Changhua Christian Hospital, Changhua,
Taiwan.
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