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

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.