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

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2024年5月6日

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Mariana Guedes,
David Gathara,
Inmaculada López-Hernández,
Pedro María Martínez Pérez-Crespo,
María Teresa Pérez-Rodríguez,
Adrian Sousa,
Antonio Plata,
Jose María Reguera-Iglesias,
Lucía Boix-Palop,
Beatriz Dietl,
Juan Sevilla Blanco,
Carlos Armiñanzas Castillo,
Fátima Galán-Sánchez,
Clara Natera Kindelán,
Alfredo Jover-Saenz,
Josune Goikoetxea Aguirre,
Ana Alemán Alemán,
Teresa Marrodán Ciordia,
Alfonso del Arco Jiménez,
Jonathan Fernandez-Suarez,
Luis Eduardo Lopez-Cortes,
Jesús Rodríguez-Baño,
Eva Leon,
Inés Pérez Camacho,
David Vinuesa García,
Jordi Cuquet Pedragosa,
Isabel María Reche Molina,
Alberto Bahamonde-Carrasco,
Carmen Herrero Rodríguez,
Marcos Guzmán García,
Antonio Sánchez-Porto,
Alejandro Smithson Amat,
Esperanza Merino de Lucas,
Jesús Canueto Quintero

摘要

Background

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.

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

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

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