KLEBSIELLA BACTEREMIA - COMMUNITY VERSUS NOSOCOMIAL INFECTION

In the period 1988-1993, 241 patients had Klebsiella bacteraemia at ou r medical centre. The annual number of patients with positive blood cu ltures increased from 306 in 1988 to 622 in 1993, representing a 4.5-6 % positivity rate of drawn cultures. In In the period 1988-1993, 241 p atients had Klebsiella bacteraemia at our medical centre. The annual n umber of patients with positive blood cultures increased from 306 in 1 988 to 622 in 1993, representing a 4.5-6% positivity rate of drawn cul tures. After E. coli, Klebsiella was the leading cause of Gram-negativ e bacteraemia. During this period, the absolute number of Klebsiella b acteraemia increased from 25 in 1988 to 84 in 1993; this represents a true increase in Klebsiella bacteraemia, from 6-7% of positive culture s in the late 1980s to 12-13% in more recent years. There were 210 cas es with K. pneumoniae and 31 with K. oxytoca. A representative sample of 80 records was retrieved and subdivided into two groups: community- acquired Klebsiella bacteraemia (CAKB) vs. hospital-acquired Klebsiell a bacteraemia (HAKB). Urinary tract infection was the underlying sourc e of 58% of CAKB vs. 28% of HAKB (p<0.01); pneumonia occurred signific antly more often in HAKB (25%) than in CAKB (7%)(p<0.01). In HAKB, as compared to CAKB, serious manifestations of illness were more common, e.g. shock (65% vs. 37%, p<0.046) and respiratory 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 ve ry common: only 57% of all Klebsiella strains were susceptible to gent amicin, 66% to ceftriaxone, 70% to ciprofloxacin, and 83% to amikacin. The susceptibility rates of Klebsiella spp isolated from patients wit h HAKB were significantly lower (p<0.001). Sepsis due to multiple-drug -resistant Klebsiella has become frequent, carrying significant morbid ity and mortality. Restriction of broad-spectrum antimicrobials in the hospital and the community as well as implementation of infection con trol measures are needed to contain this problem.