國家衛生研究院 NHRI:Item 3990099045/1985
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    题名: Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection - Risk factor for mortality and the impact of capsular serotypes as a herald for community-acquired infection
    作者: Tsay, RW;Siu, LK;Fung, CP;Chang, FY
    贡献者: Division of Clinical Research
    摘要: Background: Although several epidemiological surveys of Klebsiella clinical isolates have been performed, few studies have correlated the clinical isolate with disease. Objective: To compare the clinical and bacteriological characteristics of Klebsiella pneumoniae bacteremia acquired as community or nosocomial infections. Methods: We prospectively enrolled 158 consecutively hospitalized patients with K pneumoniae bacteremia. Clinical data were reviewed. Antimicrobial susceptibility testing and capsular serotyping were performed. We used the chi(2) test, the Fisher exact test, or the t test for statistic analysis. Results: Underlying diabetes mellitus was more,common in community-acquired than in nosocomialinfection (46/94 [49%] vs 8/64 [12%]; P<.001). On the other hand, neoplastic disease (34/64 [53%] vs 13/94 [14%]; P<.001) and antibiotic resistance (P<.01) were mare frequent in patients with nosocomial compared with community-acquired infections. Klebsiella pneumoniae liver abscesses, which were all community acquired, accounted for the source of 22 (23%) of 94 community-acquired K pneumoniae infections. No attributable source of infection was found for 37 (58%) of the 64 nosocomial infections vs 15 (16%) of the 94 community-acquired infections. Only 58 isolates (36.7%) could be serotyped; of these, capsular serotypes K1, K2, and K28 accounted for 37 (23.4%), 8 (5.1%), and 6 (3.8%), respectively, of all strains. However, typeable isolates were significantly more common among community-acquired than nosocomial isolates (42/94 [45%] vs 16/64 [25%1; P=.01), especially for serotype K1 (28/94 [30%] vs 9/64 [14%]; P=.02). Significant risk factors for mortality included nosocomial infection, lung infection, thrombocytopenia, leukopenia, ceftazidime resistance, inappropriate antimicrobial therapy, and septic shock. Conclusions: Significant differences were identified between community-acquired and nosocomial K pneumoniae bacteremia. Ceftazidime resistance in nosocomial K pneumoniae bacteremia carried a high risk for mortality, and serotype K1 in K pneumoniae was more prevalent in community-acquired infection, suggesting more virulence.
    关键词: Medicine, General & Internal
    日期: 2002-05-13
    關聯: Archives of Internal Medicine. 2002 May;162(9):1021-1027.
    Link to: http://dx.doi.org/10.1001/archinte.162.9.1021
    Cited Times(WOS): https://www.webofscience.com/wos/woscc/full-record/WOS:000175512300009
    Cited Times(Scopus): http://www.scopus.com/inward/record.url?partnerID=HzOxMe3b&scp=0037071255
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