Klebsiella bacteraemia: community versus nosocomial infection

In the period 1988-1993, 241 patients had Klebsiella bacteraemia at ourmedical centre. The annual number of patients with positive blood culturesincreased from 306 in 1988 to 622 in 1993, representing a 4.5- 6%positivity rate of drawn cultures. After E. coli, Klebsiella was theleading cause of Gram-negative bacteraemia. During this period, theabsolute number of Klebsiella bacteraemia increased from 25 in 1988 to 84in 1993; this represents a true increase in Klebsiellaa bacteraemia, from6-7% of positive cultures in the late 1980s to 12-13% in more recent years.There were 210 cases with K. pneumoniae and 31 with K. oxytoca. Arepresentative sample of 80 records was retrieved and subdivided into twogroups: community-acquired Klebsiella bacteraemia (CAKB) vs.hospital-acquired Klebsiella bacteraemia (HAKB). Urinary tract infectionwas the underlying source of 58% of CAKB vs 28% of HAKB (p < 0.01);pneumonia occurred significantly more often in HAKB (25%) than in CAKB (7%)(p < 0.01). In HAKB, as compared to CAKB, serious manifestations ofillness were more common, e.g. shock (65% vs. 37%, p < 0.046) andrespiratory failure (45% vs. 20%, p < 0.046). Overall mortality was 32%,22% of patients with CAKB died vs. 42% of those with HAKB (p < 0.05).Multiple drug resistance was very common: only 57% of all Klebsiellastrains were susceptible to gentamicin, 66% to ceftriaxone, 70% tociprofloxacin, and 83% to amikacin. The susceptibility rates of Klebsiellaspp isolated from patients with HAKB were significantly lower (p <0.001). Sepsis due to multiple-drug- resistant Klebsiellaa has becomefrequent, carrying significant morbidity and mortality. Restriction ofbroad-spectrum antimicrobials in the hospital and the community as well asimplementation of infection control measures are needed to contain thisproblem.