Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan.
Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70403, Taiwan; Department of Medicine, College of Medicine, National Cheng Kung University, 70403, Tainan, Taiwan.
J Infect Chemother. 2018 Jan;24(1):53-58. doi: 10.1016/j.jiac.2017.08.019. Epub 2017 Oct 7.
To describe the difference of the clinical features, bacteremia severity, and outcome of patient with community-onset bacteremic pneumonia between Pseudomonas, Klebsiella, and other causative microorganisms, the total 278 adults with community-onset monomicrobial bacteremic pneumonia were studied in a retrospective cohort. Klebsiella (61 patients, 21.9%) and Pseudomonas (22, 7.9%) species was the leading and the fifth common pathogen, respectively. More patients having initial presentation with critical illness (a Pitt bacteremia score ≥ 4) and a fatal comorbidity (McCabe classification) as well as a higher short- (30-day) or long-term (90-day) mortality rate was evidenced in patients infected with Klebsiella or Pseudomonas species, compared to other causative microorganisms. Compared to patients in the Klebsiella group, more frequencies of recent chemotherapy and an initial presentation of febrile neutropenia, and less proportions of diabetes mellitus were disclosed among those in the Pseudomonas group. Of importance, a significantly differential survival curve between Klebsiella or Pseudomonas species and other species during 30-day or 90-day period after bacteremia onset but a similarity of Pseudomonas and Klebsiella species was evidenced, using the Cox-regression after adjusting the independent predictors of 30-day mortality. Conclusively, of pathogens causing community-onset bacteremic pneumonia, Klebsiella and Pseudomonas species should be recognized as the highly virulent pathogens and resulted in poor short- and long-term prognoses.
为了描述社区获得性菌血症性肺炎患者中铜绿假单胞菌、肺炎克雷伯菌和其他致病微生物之间临床特征、菌血症严重程度和预后的差异，对 278 例成人社区获得性单一致病菌血症性肺炎患者进行了回顾性队列研究。肺炎克雷伯菌（61 例，21.9%）和铜绿假单胞菌（22 例，7.9%）分别是主要和第五常见的病原体。与其他致病微生物相比，感染肺炎克雷伯菌或铜绿假单胞菌的患者初始表现为危重病（Pitt 菌血症评分≥4）和致命合并症（McCabe 分类）的比例更高，以及短期（30 天）或长期（90 天）死亡率更高。与肺炎克雷伯菌组相比，铜绿假单胞菌组近期化疗和发热性中性粒细胞减少症初始表现的频率更高，而糖尿病的比例更低。重要的是，在校正 30 天死亡率的独立预测因素后，使用 Cox 回归分析显示，在菌血症发病后 30 天或 90 天期间，铜绿假单胞菌和肺炎克雷伯菌与其他细菌之间存在明显不同的生存曲线，但在 30 天期间，铜绿假单胞菌和肺炎克雷伯菌之间的生存曲线相似。总之，在引起社区获得性菌血症性肺炎的病原体中，肺炎克雷伯菌和铜绿假单胞菌应被认为是高毒力病原体，导致短期和长期预后不良。
