From the 1 School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong , Shatin, NT , Hong Kong.
Infect Dis (Lond). 2015 May;47(5):283-8. doi: 10.3109/00365548.2014.985710. Epub 2015 Feb 20.
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.
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.
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.
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.
本研究比较了香港医源性和社区获得性肺炎克雷伯菌菌血症患者的临床结局，并确定了与死亡率和高治疗费用相关的预测因素。
这是一项对教学医院肺炎克雷伯菌菌血症患者的回顾性队列研究。纳入血培养中肺炎克雷伯菌阳性的成年患者。从病历中提取人口统计学和临床数据。
分析纳入 208 例患者，平均年龄为 68.6 ± 16.8 岁，Pitt 菌血症评分 2.2 ± 2.8。共有 54.8%的病例为医源性感染。30 天死亡率为 32.7%。医源性菌血症患者的死亡率明显高于社区获得性病例（p < 0.001）。产超广谱β-内酰胺酶（ESBL）的肺炎克雷伯菌占 15.4%。腹腔内感染是最常见的感染（32.7%）。既往使用免疫抑制剂和抗菌药物是感染的两个主要易感因素。治疗费用为 12282 美元±11751 美元，住院时间为 9.0 ± 6.7 天。多变量分析显示，肝病（比值比（OR）=3.06；95%置信区间（CI）=1.38-6.78）、恶性肿瘤（OR=6.86；95%CI=3.25-14.48）、肺炎（OR=5.25；95%CI=2.05-13.41）和 Pitt 评分>1（OR=2.50；95%CI=1.25-5.00）与死亡率相关。恶性肿瘤（OR=2.94；95%CI=1.33-6.49）、Pitt 评分>1（OR=4.15；95%CI=1.87-9.24）和年龄<72 岁（OR=2.86；95%CI=1.35-5.88）与高治疗费用相关。
香港肺炎克雷伯菌菌血症患者的 30 天死亡率和治疗费用均较高。根据确定的危险因素，对患有恶性肿瘤或肝病的肺炎克雷伯菌菌血症患者进行感染控制和治疗方案非常有必要。
