Characteristics of healthcare-associated and community-acquired Klebsiella pneumoniae bacteremia in Taiwan

Objectives: 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. Methods: 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. Results: 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. Conclusions: HCA bacteremia showed different characteristics and higher mortality than CA bacteremia, but HCA infection was not an independent risk factor for mortality. (C) 2011 The British Infection Association. Published by Elsevier Ltd. All rights reserved.