Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shih-Pai Road, 112, Taipei, Taiwan.
J Infect. 2012 Feb;64(2):162-8. doi: 10.1016/j.jinf.2011.11.005. Epub 2011 Nov 11.
Klebsiella pneumoniae is the major cause of community-onset pyogenic infections in Taiwan. We investigated the clinical features and outcomes of community-acquired (CA) and healthcare-associated (HCA) infections among community-onset K. pneumoniae bacteremia.
Adult patients with community-onset monomicrobial K. pneumoniae bacteremia were analysed retrospectively at a medical centre in Taiwan over a 4-year period. We compared the clinical characteristics of patients from the CA and HCA groups and identified the risk factors for infection-related mortality.
In a total of 372 patients, HCA infections were observed in 44%. The HCA group had higher Charlson score, the Acute Physiology and Chronic Health Evaluation, version II (APACHE II) score, frequency of malignancy, rates of respiratory tract infection and bacteremia from unknown sources, and higher mortality than the CA group. Diabetes and liver abscess were predominant in the CA group. Whereas old age, APACHE II score >15, malignancy, liver cirrhosis, chronic renal failure, respiratory tract infection, skin and soft tissue infection, and inappropriate antimicrobial therapy were predictors for mortality, HCA bacteremia was not.
HCA bacteremia showed different characteristics and higher mortality than CA bacteremia, but HCA infection was not an independent risk factor for mortality.
肺炎克雷伯菌是导致台湾社区获得性化脓性感染的主要病原体。本研究旨在探讨社区获得性（CA）和医疗相关性（HCA）肺炎克雷伯菌血症的临床特征和结局。
回顾性分析了台湾某医学中心 4 年间成人社区获得性单一菌血症的肺炎克雷伯菌血症患者。比较了 CA 和 HCA 组患者的临床特征，并确定了感染相关死亡率的危险因素。
共纳入 372 例患者，其中 HCA 感染占 44%。HCA 组的 Charlson 评分、急性生理学与慢性健康评估评分 II（APACHE II）评分、恶性肿瘤发生率、呼吸道感染和不明来源菌血症的发生率均高于 CA 组，死亡率也更高。CA 组以糖尿病和肝脓肿为主。而年龄较大、APACHE II 评分>15、恶性肿瘤、肝硬化、慢性肾衰竭、呼吸道感染、皮肤软组织感染和不适当的抗菌治疗是死亡的预测因素，HCA 菌血症则不是。
HCA 菌血症与 CA 菌血症相比具有不同的特征和更高的死亡率，但 HCA 感染不是死亡的独立危险因素。
