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Background  Healthcare-associated (HCA) infection has emerged as a new epidemiological category. The aim of this study was to evaluate the impact of HCA infection on mortality in community-onset  Klebsiella pneumoniae  bloodstream infection ( Kp BSI).    Methods  We conducted a retrospective study in two tertiary-care hospitals over a 6-year period. All adult patients with  Kp BSI within 48 hours of admission were enrolled. We compared the clinical characteristics of HCA and community-acquired (CA) infection, and analyzed risk factors for mortality in patients with community-onset  Kp BSI.    Results  Of 553 patients with community-onset  Kp BSI, 313 (57%) were classified as HCA-  Kp BSI and 240 (43%) as CA- Kp BSI. In patients with HCA- Kp BSI, the severity of the underlying diseases was higher than in patients with CA- Kp BSI. Overall the most common site of infection was the pancreatobiliary tract. Liver abscess was more common in CA- Kp BSI, whereas peritonitis and primary bacteremia were more common in HCA- Kp BSI. Isolates not susceptible to extended-spectrum cephalosporin were more common in HCA-  Kp BSI than in CA- Kp BSI (9% [29/313] vs. 3% [8/240];  p =  0.006). Overall 30-day mortality rate was significantly higher in HCA- Kp BSI than in CA- Kp BSI (22% [70/313] vs .  11% [27/240];  p  = 0.001). In multivariate analysis, high Charlson’s weighted index of co-morbidity, high Pitt bacteremia score, neutropenia, polymicrobial infection and inappropriate empirical antimicrobial therapy were significant risk factors for 30-day mortality.    Conclusions  HCA- Kp BSI in community-onset  Kp BSI has distinctive characteristics and has a poorer prognosis than CA- Kp BSI, but HCA infection was not an independent risk factor for 30-day mortality.

bmc infectious diseases

Differences in characteristics between healthcare-associated and community-acquired infection in community-onset Klebsiella pneumoniae bloodstream infection in Korea