Abstract and Introduction
We initiated a worldwide collaborative study, including 455 episodes of bacteremia, to elucidate the clinical patterns of Klebsiella pneumoniae. Historically, community-acquired pneumonia has been consistently associated with K. pneumoniae. Only four cases of community-acquired bacteremic K. pneumoniae pneumonia were seen in the 2-year study period in the United States, Argentina, Europe, or Australia; none were in alcoholics. In contrast, 53 cases of bacteremic K. pneumoniae pneumonia were observed in South Africa and Taiwan, where an association with alcoholism persisted (p=0.007). Twenty-five cases of a distinctive syndrome consisting of K. pneumoniae bacteremia in conjunction with community-acquired liver abscess, meningitis, or endophthalmitis were observed. A distinctive form of K. pneumoniae infection, often causing liver abscess, was identified, almost exclusively in Taiwan.
Klebsiella pneumoniae is among the most common gram-negative bacteria encountered by physicians worldwide. It is a common hospital-acquired pathogen, causing urinary tract infections, nosocomial pneumonia, and intraabdominal infections. K. pneumoniae is also a potential community-acquired pathogen. In this international collaborative study, we evaluated geographic differences and trends in three prominent presentations of community-acquired Klebsiella infection.
First, K. pneumoniae has been a recognized pulmonary pathogen since its discovery >100 years ago. The classic clinical presentation is dramatic: toxic presentation with sudden onset, high fever, and hemoptysis (currant jelly sputum). Chest radiographic abnormalities such as bulging interlobar fissure and cavitary abscesses are prominent. However, the incidence of community-acquired Klebsiella pneumonia has apparently declined in the United States[1,2]. In studies from the 1920s to the 1960s, K. pneumoniae was considered an important cause of community-acquired pneumonia[2]; however, in the last decade K. pneumoniae accounted for <1% of cases of pneumonia requiring hospitalization in North America[3,4].
Second, a striking clinical finding concerning a new manifestation of community-acquired K. pneumoniae infections has been documented. An unusual invasive presentation of K. pneumoniae infection, primary bacteremic liver abscess, has been described by numerous investigators in Asia; >900 patients with Klebsiella liver abscess have been reported from Taiwan in the last 10 years[5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22]. In addition, case reports and small series from Korea, Singapore, Japan, India, and Thailand have been published[23,24,25,26,27,28,29,30,31,32]. The Taiwanese patients with K. pneumoniae liver abscess have no history of hepatobiliary disease. Seventy percent of such patients have diabetes mellitus[5,13,18,19]; 11% to 12% of the reported patients with Klebsiella liver abscess have other septic metastatic lesions, including pulmonary emboli or abscess, brain abscess, pyogenic meningitis, endophthalmitis, prostatic abscess, osteomyelitis, septic arthritis, or psoas abscess[5,13,19].
The third striking clinical observation is the preponderance of K. pneumoniae as a cause of community-acquired bacterial meningitis in adults in Taiwan, even in the absence of liver abscess or other sites of infection. The proportion of cases of culture-proven bacterial meningitis due to K. pneumoniae in one Taiwanese hospital increased from 8% during 1981 and 1986 to 18% during 1987 to 1995[33]. In contrast, in a recent large review only 3 (1.2%) of 253 cases of community-acquired bacterial meningitis from the Massachusetts General Hospital were due to K. pneumoniae[34].
Given these empiric observations, we established an international collaboration of researchers from each of the world's populated continents. These investigators worked in large tertiary-care hospitals or hospitals serving veterans. One of our aims was to delineate in a single time period, with a consistent set of definitions, global differences in the clinical manifestations of serious K. pneumoniae infections. We also examined the influence of prior antibiotic use on these differences in K. pneumoniae infections.
Emerging Infectious Diseases. 2002;8(2) © 2002 Centers for Disease Control and Prevention (CDC)
Cite this: Community-Acquired Klebsiella pneumoniae Bacteremia: Global Differences in Clinical Patterns - Medscape - Feb 01, 2002.
