The following is a summary of “Community-acquired Klebsiella pneumoniae pneumonia in ICU: a multicenter retrospective study,” published in the April 2024 issue of Critical Care by Grosjean et al.
Despite a global rise in hypervirulent Klebsiella pneumoniae (KP) infections, limited research on community-acquired pneumonia caused by KP (KP-CAP) suggests a concerning trend of high and rapid mortality rates.
Researchers conducted a retrospective multicenter study (7 ICUs in France, 2015-2019) to compare the prognosis and severity of community-acquired pneumonia caused by KP-CAP versus Streptococcus pneumoniae (SP-CAP).
They selected three SP-CAPs for each KP-CAP, who were admitted to ICUs within the same center and within a 6-month timeframe. Studied KP strains and genetically assessed bacterial virulence for virulence factors. The main result was in-hospital mortality. Tested associations between clinical outcomes and infection type using univariate and multivariate logistic regressions, adjusted for pairing variables.
The results showed that 27 KP-CAP and 81 SP-CAP were included. The in-hospital mortality rates were 59% (n = 16) for KP-CAP and 17% (n = 14, P<0.001) for SP-CAP, despite adequate antibiotic therapy. The median time from admission to death for KP-CAP was 26.9 h [IQR 5.75–44 h]. KP-CAP were significantly associated with higher rates of multiple organ failures (93% vs. 42%, P<0.001), disseminated intravascular coagulation (12% vs. 1.3%, P=0.046), septic shock (median lactate on ICU admission 4.60 vs. 2.90 mmol/L, P=0.030), and kidney failure (KDIGO-3: 87% vs. 44%, P<0.001). Interestingly, alcoholism was the only identified predisposing factor of KP-CAP. The severity of ICU admission was 2-fold higher for KP-CAP and was the only factor associated with mortality in a multivariate analysis.
Investigators concluded that KP-CAP caused higher and earlier deaths compared to SP-CAP, with alcoholism as a possible risk factor, urging clinician awareness and improved KP-CAP management strategies.
Source: annalsofintensivecare.springeropen.com/articles/10.1186/s13613-024-01269-3