Differences in clinical outcomes of bloodstream infections caused by Klebsiella aerogenes, Klebsiella pneumoniae and Enterobacter cloacae: a multicentre cohort study.

Humans Enterobacter cloacae / isolation & purification Klebsiella pneumoniae / isolation & purification Male Female Bacteremia / microbiology Aged Middle Aged Klebsiella Infections / mortality Enterobacter aerogenes / isolation & purification Enterobacteriaceae Infections / microbiology Cohort Studies Aged, 80 and over Anti-Bacterial Agents / therapeutic use Recurrence Treatment Outcome

Enterobacter cloacae Klebsiella aerogenes Klebsiella pneumoniae Bloodstream infection Mortality Recurrence

Journal

Annals of clinical microbiology and antimicrobials

ISSN: 1476-0711

Titre abrégé: Ann Clin Microbiol Antimicrob

Pays: England

ID NLM: 101152152

Informations de publication

Date de publication:
06 May 2024

Historique:

received: 03 03 2024

accepted: 27 04 2024

medline: 7 5 2024

pubmed: 7 5 2024

entrez: 6 5 2024

Statut: epublish

Résumé

Klebsiella aerogenes has been reclassified from Enterobacter to Klebsiella genus due to its phenotypic and genotypic similarities with Klebsiella pneumoniae. It is unclear if clinical outcomes are also more similar. This study aims to assess clinical outcomes of bloodstreams infections (BSI) caused by K. aerogenes, K. pneumoniae and Enterobacter cloacae, through secondary data analysis, nested in PRO-BAC cohort study. Hospitalized patients between October 2016 and March 2017 with monomicrobial BSI due to K. aerogenes, K. pneumoniae or E. cloacae were included. Primary outcome was a composite clinical outcome including all-cause mortality or recurrence until 30 days follow-up. Secondary outcomes were fever ≥ 72 h, persistent bacteraemia, and secondary device infection. Multilevel mixed-effect Poisson regression was used to estimate the association between microorganisms and outcome. Overall, 29 K. aerogenes, 77 E. cloacae and 337 K. pneumoniae BSI episodes were included. Mortality or recurrence was less frequent in K. aerogenes (6.9%) than in E. cloacae (20.8%) or K. pneumoniae (19.0%), but statistical difference was not observed (rate ratio (RR) 0.35, 95% CI 0.08 to 1.55; RR 0.42, 95% CI 0.10 to 1.71, respectively). Fever ≥ 72 h and device infection were more common in K. aerogenes group. In the multivariate analysis, adjusted for confounders (age, sex, BSI source, hospital ward, Charlson score and active antibiotic therapy), the estimates and direction of effect were similar to crude results. Results suggest that BSI caused by K. aerogenes may have a better prognosis than E. cloacae or K. pneumoniae BSI.

Sections du résumé

BACKGROUND BACKGROUND

METHODS METHODS

Hospitalized patients between October 2016 and March 2017 with monomicrobial BSI due to K. aerogenes, K. pneumoniae or E. cloacae were included. Primary outcome was a composite clinical outcome including all-cause mortality or recurrence until 30 days follow-up. Secondary outcomes were fever ≥ 72 h, persistent bacteraemia, and secondary device infection. Multilevel mixed-effect Poisson regression was used to estimate the association between microorganisms and outcome.

RESULTS RESULTS

Overall, 29 K. aerogenes, 77 E. cloacae and 337 K. pneumoniae BSI episodes were included. Mortality or recurrence was less frequent in K. aerogenes (6.9%) than in E. cloacae (20.8%) or K. pneumoniae (19.0%), but statistical difference was not observed (rate ratio (RR) 0.35, 95% CI 0.08 to 1.55; RR 0.42, 95% CI 0.10 to 1.71, respectively). Fever ≥ 72 h and device infection were more common in K. aerogenes group. In the multivariate analysis, adjusted for confounders (age, sex, BSI source, hospital ward, Charlson score and active antibiotic therapy), the estimates and direction of effect were similar to crude results.

CONCLUSIONS CONCLUSIONS

Results suggest that BSI caused by K. aerogenes may have a better prognosis than E. cloacae or K. pneumoniae BSI.

Identifiants

DOI: 10.1186/s12941-024-00700-8 PMID: 38711045

pubmed: 38711045

doi: 10.1186/s12941-024-00700-8

pii: 10.1186/s12941-024-00700-8

doi:

Substances chimiques

Anti-Bacterial Agents 0

Types de publication

Journal Article Multicenter Study

Langues

eng

Sous-ensembles de citation

Pagination

Subventions

Organisme : Plan Nacional de I + D + i 2013-2016, Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades

ID : PI16/01432

Organisme : Spanish Network for Research in Infectious Diseases (REIPI)

ID : RD16/0016/0001

Organisme : Spanish Network for Research in Infectious Diseases (REIPI)

ID : RD16/0016/0008

Investigateurs

Eva Leon (E)

Inés Pérez Camacho (IP)

David Vinuesa García (DV)

Jordi Cuquet Pedragosa (JC)

Isabel María Reche Molina (IMR)

Alberto Bahamonde-Carrasco (A)

Carmen Herrero Rodríguez (CH)

Marcos Guzmán García (MG)

Antonio Sánchez-Porto (A)

Alejandro Smithson Amat (AS)

Esperanza Merino de Lucas (EM)

Jesús Canueto Quintero (JC)

Informations de copyright

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