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Open Access Research article

Differences in characteristics between healthcare-associated and community-acquired infection in community-onset Klebsiella pneumoniae bloodstream infection in Korea

Younghee Jung1, Myung Jin Lee3, Hye-Yun Sin1, Nak-Hyun Kim3, Jeong-Hwan Hwang3, Jinyong Park3, Pyoeng Gyun Choe35, Wan Beom Park35, Eu Suk Kim15, Sang-Won Park5, Kyoung Un Park25, Hong Bin Kim15, Nam-Joong Kim35, Eui-Chong Kim45, Kyoung-Ho Song15* and Myoung-don Oh35

Author Affiliations

1 Department of Internal Medicine, Seoul National University Bundang Hospital, 173 Gumi-ro, Bundang-gu, Seongnam, 463-707, Republic of Korea

2 Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

3 Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea

4 Department of Laboratory Medicine, Seoul National University Hospital, Seoul, Korea

5 Seoul National University College of Medicine, Seoul, Korea

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BMC Infectious Diseases 2012, 12:239  doi:10.1186/1471-2334-12-239

Published: 3 October 2012

Abstract

Background

Healthcare-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).

Methods

We 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.

Results

Of 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.

Conclusions

HCA-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.

Keywords:
Klebsiella pneumoniae; Bacteremia; Community-acquired infections; Healthcare-associated; Community-onset infection; Epidemiology