BACKGROUND: We compared clinical outcomes between patients with healthcare-associated and community-acquired Klebsiella pneumoniae bacteraemia and identified predictors associated with mortality and high treatment cost in Hong Kong. METHODS: This was a retrospective cohort study of patients with K. pneumoniae bacteraemia in a teaching hospital. Adult patients with K. pneumoniae in blood cultures were included. Demographics and clinical data were retrieved from medical records. RESULTS: The analysis included 208 patients. The mean age was 68.6 ± 16.8 years. The Pitt bacteraemia score was 2.2 ± 2.8. In all, 54.8% cases were healthcare-associated infections. The 30-day mortality rate was 32.7%. The mortality rate of patients with healthcare-associated bacteraemia was significantly higher than for community-acquired cases (p < 0.001). Extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae accounted for 15.4% of cases. Intra- abdominal infection was the most common infection (32.7%). Prior use of immunosuppressive agents and antimicrobial therapy were two major predisposing factors for infection. The treatment cost was USD12 282 ± 11 751 and the length of hospitalization was 9.0 ± 6.7 days. Multivariate analysis showed that liver disease (odds ratio (OR) = 3.06; 95% confidence interval (CI) = 1.38-6.78), malignancy (OR = 6.86; 95% CI = 3.25-14.48), pneumonia (OR = 5.25; 95% CI = 2.05-13.41) and Pitt score > 1 (OR = 2.50; 95% CI = 1.25-5.00) were associated with mortality. Malignancy (OR = 2.94; 95% CI = 1.33-6.49), Pitt score > 1 (OR = 4.15; 95% CI = 1.87-9.24) and age < 72 years (OR = 2.86; 95% CI = 1.35-5.88) were associated with high treatment cost. CONCLUSIONS: The 30-day mortality and treatment cost of patients with K. pneumoniae bacteraemia were high in Hong Kong. Based upon the risk factors identified, infection control and treatment algorithms for K. pneumoniae bacteraemia in patients with malignancy or liver disease are highly warranted.
BACKGROUND: We compared clinical outcomes between patients with healthcare-associated and community-acquired Klebsiella pneumoniae bacteraemia and identified predictors associated with mortality and high treatment cost in Hong Kong. METHODS: This was a retrospective cohort study of patients with K. pneumoniae bacteraemia in a teaching hospital. Adult patients with K. pneumoniae in blood cultures were included. Demographics and clinical data were retrieved from medical records. RESULTS: The analysis included 208 patients. The mean age was 68.6 ± 16.8 years. The Pitt bacteraemia score was 2.2 ± 2.8. In all, 54.8% cases were healthcare-associated infections. The 30-day mortality rate was 32.7%. The mortality rate of patients with healthcare-associated bacteraemia was significantly higher than for community-acquired cases (p < 0.001). Extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae accounted for 15.4% of cases. Intra- abdominal infection was the most common infection (32.7%). Prior use of immunosuppressive agents and antimicrobial therapy were two major predisposing factors for infection. The treatment cost was USD12 282 ± 11 751 and the length of hospitalization was 9.0 ± 6.7 days. Multivariate analysis showed that liver disease (odds ratio (OR) = 3.06; 95% confidence interval (CI) = 1.38-6.78), malignancy (OR = 6.86; 95% CI = 3.25-14.48), pneumonia (OR = 5.25; 95% CI = 2.05-13.41) and Pitt score > 1 (OR = 2.50; 95% CI = 1.25-5.00) were associated with mortality. Malignancy (OR = 2.94; 95% CI = 1.33-6.49), Pitt score > 1 (OR = 4.15; 95% CI = 1.87-9.24) and age < 72 years (OR = 2.86; 95% CI = 1.35-5.88) were associated with high treatment cost. CONCLUSIONS: The 30-day mortality and treatment cost of patients with K. pneumoniae bacteraemia were high in Hong Kong. Based upon the risk factors identified, infection control and treatment algorithms for K. pneumoniae bacteraemia in patients with malignancy or liver disease are highly warranted.
Entities:
Keywords:
Hong Kong; Klebsiella pneumoniae; bacteraemia; cost; mortality
Authors: Margaret Ip; Christopher K Lai; Kitty S C Fung; K-Tak Wong; Chendi Zhu; Sebastien Van de Velde; Dominic N Tsang; Peter Hawkey Journal: Eur J Clin Microbiol Infect Dis Date: 2017-08-25 Impact factor: 3.267