Risk Factors and Outcome of Klebsiella Pneumoniae Bacteraemia In Adult
Creators: name: Lee, Tiong Chan
name: Md Arif Asma
name: Razali Nurul Huda
name: Kulasingham Vicknesan
name: Sukesh Hashvina
name: Voon-Yaa Tay
name: Ghazali Mohd Ashraf
name: Ewe Jin Koh
name: Sitinah, Omar
name: Hamizan, Othman
name: Phang Teck Toh
Publisher: name: Zenodo
Year: 2020
Subjects: Klebsiella Pneumoniae
Bacteraemia
Adults
Risk Factors
Outcome

description: <strong>Introduction </strong>Klebsiella pneumoniae bacteraemia is a major cause of morbidity and mortality in hospitals. Multidrug resistance associated with extended spectrum β lactamase and K. pneumoniae carbapenemase ( KPC ) organisms is a growing health threat. The purposes of this study is determine the demographic patterns, risk factors and outcome of K. pneumoniae bacteraemia in tertiary hospital in the Southern region of Malaysia. <strong>Methods</strong> Single-center retrospective analysis involving all adults with K. pneumoniae bacteraemia in Sultan Ismail Hospital, Johor Bahru, Malaysia in 2016. Data on demographic patterns , risk factors , medical comorbidities , source of infection and in hospital mortality were obtained from the electronic medical records. 24,143 adult admissions with 5714 blood culture samples collected , of which 1124 ( 19.7 % ) were positive cultures. 825 blood culture samples met eligibility criterias. 299 samples were excluded as they were deemed clinically insignificant or contaminant •Analysis of data performed using SPSS version 18. A p-value of &lt;0.05 was considered statistically significant. <strong>Results </strong>Gram negative bacteraemia accounted for 69.2 % of total positive blood cultures . Klebsiella pneumoniae was the commonest blood-stream pathogen (185 cases, 22.4 %) followed by Escherichia coli (179 cases , 21.7 %) and Staphylococcus aureus (153 cases, 18.4 %), Streptococcus spp (75 cases, 9.1 %) and Acinetobacter spp (42 cases, 5.1 %) Mean age was 54.9 ( SD 15.4 ) with an overall in-hospital mortality rate of 46.5 %. Extended Spectrum Beta Lactamase (ESBL) producing and Carbapenem resistant K. pneumoniae accounted for 37.3% (n= 69) and 1.1 % (n= 2) cases respectively (Table 1) The common sources of K. pneumoniae bacteraemia were primary bloodstream infections (40.5 % , n=75) , followed by pneumonia (23.8%, n= 44) and urinary tract infection (15.1%, n=28), liver abscess ( 6.5%, n=12) and skin and soft tissue infection ( 4.3 %, n=8) (Chart 1). Older age ( p=0.005 ) and chronic liver disease (p= 0.008) were predictors of in-hospital mortality (Table 3). <strong>Discussion </strong>Gram negative bacteraemia accounted for 69.2 % of total positive blood cultures , compared to a study conducted in a teaching hospital in Kuala Lumpur 2 decades ago which reported higher Gram positive bacteraemia (56.7 % of the blood cultures) (1). K.pneumoniae has surpassed Escherichia coli to become the predominant gram negative pathogen in our institution ( 22.4 % versus 21.7 %). Multidrug resistance associated with extended spectrum β lactamase (37.3 %) and K. pneumoniae carbapenemase (1.1%) organisms is a growing health threat. Diabetes mellitus , cancer and alcohol use disorders were risk factors associated with K. pneumoniae bacteraemia similar to previous reported study. Overall in-hospital mortality rate of 46.5% , similar to other reported study. Older age and chronic liver disease were associated with higher mortality rate. <strong>Conclusion</strong> Diabetes mellitus , cancer and alcohol use disorders were independent risk factors associated with Klebsiella pneumoniae bacteraemia. Higher mortality rate was observed in elderly and patients with chronic liver disease.