Clinical predictors and outcome of Klebsiella pneumoniae bacteremia in a regional hospital in Hong Kong
Creators: name: Man, Man Yee
name: Shum, Hoi Ping
name: Chan, Yan Hei
name: Chan, King Chung Kenny
name: Yan, Wing Wa
name: R.A. Lee
name: Lau, Susanna K.P.
Publisher: name: F1000Research
Year: 2017

description: Background:<br>Klebsiella pneumoniae bacteraemia is associated with high mortality in general wards and in intensive care units. The emergence of multi-drug resistant Klebsiella infection, for example carbapenemase-resistant (CR) Klebsiella pneumonia and extended spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae is an increasing threat with significant morbidity and mortality worldwide. <br><br>Methods:<br>Adult patients either with diagnosis of Klebsiella pneumonia bacteraemia or blood culture growing Klebsiella pneumonia were analyzed retrospectively in the period from January 2009 to June 2016. Clinical and microbiological characteristics were analyzed. Disease severity was compared by total SOFA score and the need for organ support i.e. renal replacement therapy, mechanical ventilation and vasopressor use. Risk factors for mortality were identified and further reviewed by regression analysis.<br><br>Results:<br>A total of 853 cases were included, with 176 patients dying within 30 days (mortality of 20.6%) and 178 patients being admitted to ICU. Univariate analysis showed those aged &gt;65, admitted to medical ward, presented with septic shock, required organ support and had higher SOFA scores were associated with higher 30-day mortality. Successful empirical antibiotic treatment, hepatobiliary tract and urogenital tract infections were associated with better 30-day mortality; whereas respiratory tract (HR=2.99; 95% CI=2.061-4.337;p=&lt;0.001)and gastrointestinal tract infection (HR=2.763; 95% CI= 1.761-4.337; p=&lt;0.001), use of mechanical ventilation (HR=2.202; 95% CI=1.506-3.221; p=&lt;0.001), medical specialty (HR=1.830; 95% CI=1.253-2.672; p=0.002), advanced age (HR=1.692; 95% CI=1.160-2.467; p=0.006), presence of solid tumor [Hazard ratio (HR)=1.457; 95% CI=1.056-2.009; p=0.022] and unsuccessful empirical antibiotics (HR=1.716; 95% CI=1.267-2.324; p=&lt;0.001), are independent predictors for mortality in Cox regression analysis. Diabetic patients were however unexpectedly associated with a better 30-day mortality.<br> <br>In sub-group analysis of ESBL-Klebsiella pneumonia disease, patients with solid tumor, previous steroid usage within 30 days before positive blood culture, non-hepatobiliary sepsis and presence of central venous catheters are predictors for presence of ESBL-Klebsiella pneumoniae bacteremia from logistic regression analysis. ESBL-Klebsiella pneumoniae bacteremia was however not associated with an increased risk of mortality. Not surprisingly, those with ESBL disease had a lower rate of successful empirical antibiotics and longer hospital length of stay. <br><br>Conclusions:<br>Klebsiella pneumonia bacteremia is associated with high mortality (around 20%) in a regional hospital in Hong Kong. Advanced age, need for organ support, unsuccessful empirical antibiotic treatment and presence of solid tumor are independent predictors of mortality. These results were in consensus with previous studies worldwide. Clinical awareness of early appropriate and adequate empirical antibiotics is of paramount importance. Further investigations will be essential in setting and implementing clinical guidelines in the management of Klebsiella pneumoniae bacteremia.