Article Figures & Data
Figures
- Figure 1
- Flow chart of patients selected. K. pneumoniae: Klebsiella pneumoniae, E. coli: Escherichia coli.
Tables
- Table 1
- Clinical characteristics of patients with Klebsiella pneumoniae and Escherichia coli bacteremic pneumonia.
Variables All (n=162) Bacteremic pneumonia P-values K. pneumoniae (n=80) E. coli (n=82) Age, mean±SD (years) 60.97±16.15 59.85±16.89 62.06±15.42 0.482 Gender Male 95 (58.6) 56 (70.0) 39 (47.6) 0.004 Female 67 (41.4) 24 (30.0) 43 (52.4) Acquisition Hospital-acquired 117 (72.2) 60 (75.0) 57 (69.5) 0.436 Community-acquired 45 (27.8) 20 (25.0) 25 (30.5) Inpatient Department Internal medicine 79 (48.8) 38 (47.5) 41 (50.0) 0.750 Surgery ward 35 (21.6) 10 (12.5) 25 (30.5) 0.005 ICU 33 (20.4) 27 (33.7) 6 (7.3) <0.001 Invasive procedures Surgery 39 (24.1) 16 (20.0) 23 (28.0) 0.660 Venous catheterization 26 (16.0) 16 (20.0) 10 (12.2) 0.176 Wound drainage tube 12 (7.4) 5 (6.2) 7 (8.5) 0.578 Indwelling urinary catheter 22 (13.6) 16 (20.0) 6 (7.3) 0.018 Bone marrow aspiration 22 (13.6) 10 (12.5) 12 (14.6) 0.692 Lumbar puncture 9 (5.6) 6 (7.5) 3 (3.7) 0.469 Thoracentesis 6 (3.7) 4 (5.0) 2 (2.4) 0.655 Tracheotomy 45 (27.8) 34 (42.5) 11 (13.4) <0.001 Trachea cannula 39 (24.1) 30 (37.5) 9 (11.0) <0.001 Bacterial type ESBL-producing strains 53 (32.7) 12 (15.0) 41 (50.0) <0.001 Carbapenem-resistant strains 30 (18.5) 29 (36.2) 1 (1.2) <0.001 Underlying disease Immune compromise 44 (27.2) 27 (33.7) 17 (20.7) 0.063 Cerebral vascular disease 51 (31.5) 31 (38.7) 20 (24.4) 0.049 Hypertension 60 (37.0) 30 (37.5) 30 (36.6) 0.904 Diabetes mellitus 25 (15.4) 19 (23.7) 6 (7.3) 0.004 Pleural effusion 34 (21.0) 15 (18.7) 19 (23.2) 0.490 Hypoproteinaemia 45 (27.8) 24 (30.0) 21 (25.6) 0.533 Leukaemia 25 (15.4) 14 (17.5) 11 (13.4) 0.472 Sepsis 122 (75.3) 74 (92.5) 48 (58.5) <0.001 Laboratory values, median (IQR) CRP (mg/L) 92.61 (48.36-148.58) 98.42 (59.51-153.73) 77.13 (27.35-147.42) 0.093 PCT (ng/ml) 2.72 (0.94-11.21) 3.96 (1.02-11.96) 1.90 (0.78-10.91) 0.116 Disease severity, median (IQR) Pitt score 1.0 (2.0-5.0) 3.0 (1.0-6.0) 1.0 (0.0-2.0) <0.001 SOFA score 5.0 (3.0-8.0) 5.0 (4.0-9.0) 3.0 (1.0-6.0) <0.001 aCCI score 4.0 (2.0-5.0) 4.0 (2.5-6.0) 4.0 (2.0-5.0) 0.962 Empiric therapy Third-generation cephalosporins 14 (8.6) 3 (3.7) 11 (13.4) 0.029 BLBLI 54 (33.3) 23 (28.7) 31 (37.8) 0.222 Carbapenems 64 (39.5) 41 (51.2) 23 (28.0) 0.003 Aminoglycoside 4 (2.5) 3 (3.7) 1 (1.2) >0.999 Inappropriate empirical therapy 53 (32.7) 32 (40.0) 21 (25.6) 0.051 Antibiotics ≥3 during hospitalization 49 (30.2) 27 (33.7) 22 (26.8) 0.338 Outcomes 14-day treatment failure 75 (46.3) 50 (62.5) 25 (30.5) <0.001 30-day mortality 53 (32.7) 35 (43.7) 18 (21.9) 0.003 Length of hospital stay in days, median(IQR) 21.0 (13.0-31.0) 24.0 (14.0-34.0) 18.0 (12.0-25.0) 0.097 Values are presented as numbers and precentages (%), mean ± standard deviation (SD), or median and interquartile range (IQR). K. pneumoniae: Klebsiella pneumoniae, E. coli: Escherichia coli, ICU: intensive care unit, ESBL: extended-spectrum β-lactamase, CRP: C-reaction protein, PCT: procalcitonin, Pitt: Pitt bacteremia score, SOFA: sequential organ failure assessment, aCCI: age-adjusted Charlson comorbidity index, BLBLI: β-lactam-β-lactamase inhibitor
- Table 2
- Antimicrobial resistance of Klebsiella pneumoniae and Escherichia coli isolated from 2 groups.
Antimicrobials Klebsiella pneumoniae (n=80) Escherichia coli (n=82) P-value* S I R S I R Amikacin 64 (80.0) - 16 (20.0) 81 (98.8) - 1 (1.2) <0.001 Aztreonam 41 (51.2) - 39 (48.7) 56 (68.3) - 26 (31.7) 0.027 Ciprofloxacin 33 (41.2) 4 (5.0) 43 (53.7) 33 (40.2) 5 (6.1) 44 (53.7) 0.896 Gentamicin 57 (71.2) - 23 (28.7) 49 (59.8) - 33 (40.2) 0.124 Ceftriaxone 40 (50.0) - 40 (50.0) 37 (45.1) - 45 (54.9) 0.534 Cefoxitin 46 (57.5) 2 (2.5) 32 (40.0) 62 (75.6) 5 (6.1) 15 (18.3) 0.015 Cefixime 44 (55.0) - 36 (45.0) 67 (81.7) - 15 (18.3) <0.001 Tobramycin 56 (70.0) 5 (6.2) 19 (23.7) 45 (54.9) 29 (36.4) 8 (9.8) 0.328 Imipenem 51 (63.7) - 29 (36.2) 81 (98.8) - 1 (1.2) <0.001 Levofloxacin 34 (42.5) 9 (11.2) 37 (46.2) 16 (19.5) 33 (40.2) 33 (40.2) 0.002 Piperacillin 48 (60.0) 3 (3.7) 29 (36.2) 76 (92.7) 5 (6.1) 1 (1.2) <0.001 Values are presented as numbers and precentages (%).
S: susceptible, I: intermediate-resistant, R: resistant
↵* Comparison of antimicrobial susceptibility between 2 groups.
- Table 3
- Hazard ratio for 30-day mortality according to Klebsiella pneumoniae bacteremic pneumonia and Escherichia coli bacteremic pneumonia.
30-day mortality Events (total) HR (95% CI) Model 1 Model 2 Model 3 Model 4 KP-BP 35 (43.7) 0.70 (0.44-1.02) 0.72 (0.46-1.14) 0.99 (0.57-1.73) 1.22 (0.69-2.18) E. coli-BP 18 (21.9) Ref Ref Ref Ref P-values 0.003 0.059 0.163 0.975 0.493 Values are presented as numbers and precentages (%) or, hazard ratio (HR) and 95% confidence interval (CI). Model 1: adjusted for age, gender, inpatient department (surgery ward and ICU), and invasive procedures (indwelling urinary catheter, tracheotomy, trachea cannula). Model 2: further adjusted for bacterial type. Model 3: further adjusted for underlying disease (cerebral vascular disease, diabetes mellitus, and sepsis), pitt score, and SOFA score. Model 4: further adjusted for empiric therapy (third-generation cephalosporins and carbapenems) and 14-day treatment failure. KP-BP: Klebsiella pneumoniae bacteremic pneumonia, E. coli-BP: Escherichia coli bacteremic pneumonia
Variables Bacteremic pneumonia K. pneumoniae (n=80) E. coli (n=82) Survivors (n=45) Non-survivors (n=35) P-values Survivors (n=64) Non-survivors (n=18) P-values Age, mean±SD (years) 58.31±16.43 61.83±17.51 0.386 62.31±14.66 61.17±18.30 0.949 Gender Male 33 (73.3) 23 (65.7) 0.461 28 (43.7) 11 (61.1) 0.289 Female 12 (26.7) 12 (34.3) 36 (56.2) 7 (38.9) Acquisitions Hospital-acquired 31 (68.9) 29 (82.9) 0.152 43 (67.2) 14 (77.8) 0.389 Community-acquired 14 (31.1) 6 (17.1) 21 (32.8) 4 (22.2) Inpatient departments Internal medicine 25 (55.6) 13 (37.1) 0.005 31 (48.4) 10 (55.5) 0.594 Surgery ward 8 (17.8) 2 (5.7) 0.201 20 (31.2) 5 (27.8) 0.777 ICU 8 (17.8) 19 (54.3) 0.001 4 (6.2) 2 (11.1) 0.851 Invasive procedures Surgery 12 (26.7) 4 (11.4) 0.091 18 (28.1) 5 (27.8) 0.977 Venous catheterization 4 (8.9) 12 (34.3) 0.005 6 (9.4) 4 (22.2) 0.287 Wound drainage tube 2 (4.4) 3 (8.6) 0.771 6 (9.4) 1 (5.6) 0.972 Indwelling urinary catheter 10 (22.2) 6 (17.1) 0.573 4 (6.2) 6 (33.3) 0.002 Bone marrow aspiration 6 (13.3) 4 (11.4) 0.798 7 (10.9) 5 (27.8) 0.159 Lumbar puncture 5 (11.1) 1 (2.9) 0.336 2 (3.1) 1 (5.6) 0.627 Thoracentesis 2 (4.4) 2 (5.7) 0.796 2 (3.1) 0 (0.0) >0.999 Tracheotomy 11 (24.4) 23 (65.7) <0.001 4 (6.2) 7 (38.9) 0.001 Trachea cannula 11 (24.4) 19 (54.3) <0.001 4 (6.2) 5 (27.8) 0.031 Bacterial types ESBL-producing strains 6 (13.3) 6 (17.1) 0.636 29 (45.3) 12 (66.7) 0.109 Carbapenem-resistant strains 10 (22.2) 19 (42.2) 0.003 1 (1.6) 0 (0.0) >0.999 Underlying diseases Immune compromise 14 (31.1) 13 (37.1) 0.571 13 (20.3) 4 (22.2) 0.860 Cerebral vascular disease 12 (26.7) 19 (54.3) 0.012 16 (25.0) 4 (22.2) 0.808 Hypertension 18 (40.0) 12 (34.3) 0.600 25 (39.1) 5 (27.8) 0.380 Diabetes mellitus 13 (28.9) 6 (17.1) 0.221 4 (6.2) 2 (11.1) 0.484 Pleural effusion 7 (15.6) 8 (22.9) 0.407 14 (21.9) 5 (27.8) 0.600 Hypoproteinaemia 8 (17.8) 16 (45.7) 0.007 15 (23.4) 6 (33.3) 0.236 Leukaemia 5 (11.1) 9 (25.7) 0.088 6 (9.4) 5 (27.8) 0.103 Sepsis 40 (88.9) 34 (97.1) 0.336 33 (51.6) 15 (83.3) 0.016 Laboratory values, median (IQR) CRP (mg/L) 106.83 (69.40-156.75) 79.13 (45.33-141.97) 0.198 78.09 (23.45-145.15) 77.13 (47.66-165.76) 0.521 PCT (ng/ml) 2.84 (1.06--12.90) 4.86 (0.94-11.54) 0.956 1.89 (0.77-8.32) 4.26 (0.76-28.61) 0.445 Disease severity, median (IQR) Pitt score 2.0 (1.0-3.0) 5.0 (2.0-8.0) <0.001 0.0 (1.0-1.0) 4.5 (2.0-6.5) <0.001 SOFA score 5.0 (3.0-5.0) 9.0 (5.0-14.0) <0.001 3.0 (1.0-4.0) 7.5 (3.5-12.5) <0.001 aCCI score 3.0 (2.0-5.0) 4.0 (3.0-6.0) 0.047 4.0 (2.0-5.0) 4.0 (2.50-5.0) 0.688 Empiric therapy Third-generation cephalosporins 3 (6.7) 0 (0.0) 0.335 8 (12.5) 3 (16.7) 0.947 BLBLI 14 (31.1) 9 (25.7) 0.597 27 (42.2) 4 (22.2) 0.123 Carbapenems 21 (46.7) 20 (57.1) 0.352 17 (26.6) 6 (33.3) 0.572 Aminoglycoside 2 (4.4) 1 (2.9) >0.999 1 (1.6) 0 (0.0) >0.999 Inappropriate empirical therapy 13 (28.9) 19 (54.3) 0.021 13 (20.3) 8 (44.4) 0.077 Antibiotics ≥3 during hospitalization 11 (24.4) 16 (45.7) 0.046 15 (23.4) 7 (38.9) 0.314 14-day treatment failure 18 (40.0) 32 (91.4) <0.001 8 (12.5) 17 (94.4) <0.001 Length of hospital stay, median (IQR) (day) 25.0 (17.0-35.5) 22.0 (10.0-31.0) 0.111 19.0 (11.0-28.0) 14.5 (11.5-28.0) 0.354 Time interval between IEAT and AAT, median (IQR) (day) 4.0 (3.0-5.0) 3.0 (3.0-4.0) 0.055 5.0 (4.0-5.0) 5.0 (4.0-6.0) 0.056 Values are presented as numbers and precentages (%), mean ± standard deviation (SD), or median and interquartile range (IQR). K. pneumoniae: Klebsiella pneumoniae, E. coli: Escherichia coli, ICU: intensive care unit, ESBL: extended-spectrum β-lactamase, CRP: C-reaction protein, PCT: procalcitonin, SOFA: sequential organ failure assessment, Pitt: Pitt bacteremia score, aCCI: age-adjusted Charlson comorbidity index, BLBLI: β-lactam-β-lactamase inhibitor, IEAT: inappropriate empirical antibiotic treatment, AAT: appropriate antibiotic therapy
- Table 5
- Risk factors for 30-day mortality in patients with Klebsiella pneumoniae and Escherichia coli bacteremic pneumonia.
Variables Patients with K. pneumoniae bacteremic pneumonia Patients with E. coli bacteremic pneumonia Univariate Multivariate Univariate Multivariate HR 95% CI P-values HR 95% CI P-values HR 95% CI P-values HR 95% CI P-values Internal medicine stay 0.58 0.29-1.19 0.136 - - - ICU stay 3.14 1.59-6.22 0.001 2.88 1.42-5.82 0.003 4.79 1.84-12.44 0.001 - - - Venous catheterization 2.67 1.31-5.45 0.007 - - - 3.73 1.32-10.59 0.013 - - - Indwelling urinary catheter 1.37 0.32-5.99 0.673 - - - Tracheotomy 3.36 1.63-6.91 0.001 - - - 4.79 1.84-12.44 0.001 - - - Trachea cannula 2.65 1.34-5.23 0.005 - - - 3.73 1.32-10.59 0.013 - - - Carbapenem-resistant strains 2.66 1.34-5.24 0.005 2.61 1.28-5.32 0.008 Cerebral vascular disease 1.60 0.80-3.18 0.180 - - - Sepsis 3.66 1.06-12.66 0.041 - - - Hypoproteinaemia 1.64 0.82-3.27 0.163 - - - Pitt score 1.19 1.09-1.31 <0.001 - - - 1.49 1.29-1.72 <0.001 1.99 1.49-2.65 <0.001 SOFA score 1.18 1.11-1.26 <0.001 1.16 1.09-1.25 <0.001 1.22 1.12-1.32 <0.001 - - - aCCI score 1.14 1.00-1.31 0.059 - - - Antibiotics ≥3 during hospitalization 1.35 0.69-2.67 0.384 - - - Inappropriate empirical therapy 2.35 1.19-4.64 0.014 - - - K. pneumoniae: Klebsiella pneumoniae, E. coli: Escherichia coli, ICU: intensive care unit, HR: hazard ratio, CI: confidence interval, SOFA: sequential organ failure assessment, Pitt: Pitt bacteremia score, aCCI: age-adjusted Charlson comorbidity index
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