Kuo Tsung-Hang, Yang Chao-Yung, Lee Chung-Hsun, Hsieh Chih-Chia, Ko Wen-Chien, Lee Ching-Chi
Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Institute of Clinical Medicine, National Cheng Kung University Department of Medicine, College of Medicine, National Cheng Kung University Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University Division of Critical Care Medicine, Department of Internal Medicine, Madou Sin-Lau Hospital Graduate Institute of Medical Sciences, College of Health Sciences, Chang Jung Christian University, Tainan, Taiwan.
Medicine (Baltimore). 2017 Jun;96(26):e7075. doi: 10.1097/MD.0000000000007075.
Bacteremia is a life-threatening condition that is associated with substantial healthcare costs. Escherichia coli and Klebsiella pneumoniae are the leading causes of community-onset gram-negative bacteremia. However, a comprehensive comparison between these pathogens involved in bacteremia episodes has yet to be reported.In this retrospective cohort study, adults with community-onset monomicrobial bacteremia caused by E coli or K pneumoniae were recruited in the emergency department of a medical center during a 6-year period, and the clinical variables were collected retrospectively from medical records. The complicated abscess occurrence was determined through imaging studies, according to the opinion of an infectious disease consultant. According to the independent predictors of 28-day mortality identified through multivariate regression analyses, patients in the E coli group were propensity score matched (PSM) in a 1:1 ratio to those in the K pneumoniae group.A total of 274 and 823 adults with K pneumoniae and E coli bacteremia were included in the present study. The K pneumoniae group had more patients with fatal comorbidities (McCabe classification), critical illness (Pitt bacteremia score ≥ 4) at bacteremia onset, and initial syndrome (e.g., severe sepsis and septic shock) as well as a higher crude mortality rate than did the E coli group. After appropriate matching, no significant differences were observed in the critical illness at bacteremia onset, initial syndrome, major comorbidities, and comorbidity severity of the 2 groups (E coli, n = 242; K pneumoniae, n = 242). Furthermore, despite similar 14- and 28-day crude mortality rates between the 2 PSM groups, more frequent abscess occurrences and a longer length of hospitalization were observed in the K pneumoniae group than in the E coli group.Conclusively, numerous clinical features at initial presentations varied between the E coli and K pneumoniae groups. Despite conducting a PSM analysis to control the differences in the baseline characteristics, a longer length of hospitalization and more frequent abscess occurrences were observed in the K pneumoniae group than in the E coli group.
菌血症是一种危及生命的病症，与高昂的医疗费用相关。大肠杆菌和肺炎克雷伯菌是社区获得性革兰氏阴性菌血症的主要病因。然而，尚未有关于这些引发菌血症发作的病原体之间的全面比较报道。
在这项回顾性队列研究中，在6年期间于一家医疗中心的急诊科招募了由大肠杆菌或肺炎克雷伯菌引起社区获得性单微生物菌血症的成年人，并从病历中回顾性收集临床变量。根据感染病顾问的意见，通过影像学检查确定是否发生复杂脓肿。根据多变量回归分析确定的28天死亡率的独立预测因素，将大肠杆菌组的患者与肺炎克雷伯菌组的患者按1:1的比例进行倾向评分匹配（PSM）。
本研究共纳入了274例肺炎克雷伯菌菌血症患者和823例大肠杆菌菌血症患者。肺炎克雷伯菌组比大肠杆菌组有更多患有致命合并症（麦凯布分类）、菌血症发作时处于危重病状态（皮特菌血症评分≥4）和初始综合征（如严重脓毒症和感染性休克）的患者，且粗死亡率更高。经过适当匹配后，两组（大肠杆菌组，n = 242；肺炎克雷伯菌组，n = 242）菌血症发作时的危重病状态、初始综合征、主要合并症和合并症严重程度方面未观察到显著差异。此外，尽管两个PSM组之间14天和28天的粗死亡率相似，但肺炎克雷伯菌组比大肠杆菌组观察到更频繁的脓肿发生和更长的住院时间。
总之，大肠杆菌组和肺炎克雷伯菌组在初始表现时的众多临床特征有所不同。尽管进行了PSM分析以控制基线特征的差异，但肺炎克雷伯菌组比大肠杆菌组观察到更长的住院时间和更频繁的脓肿发生。
