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
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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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusions: </strong>Results suggest that BSI caused by K. aerogenes may have a better prognosis than E. cloacae or K. pneumoniae BSI.</p>","PeriodicalId":8052,"journal":{"name":"Annals of Clinical Microbiology and Antimicrobials","volume":null,"pages":null},"PeriodicalIF":4.6000,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11071190/pdf/","citationCount":"0","resultStr":"{\"title\":\"Differences in clinical outcomes of bloodstream infections caused by Klebsiella aerogenes, Klebsiella pneumoniae and Enterobacter cloacae: a multicentre cohort study.\",\"authors\":\"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\",\"doi\":\"10.1186/s12941-024-00700-8\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Klebsiella aerogenes has been reclassified from Enterobacter to Klebsiella genus due to its phenotypic and genotypic similarities with Klebsiella pneumoniae. 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引用次数: 0
摘要
背景：由于其表型和基因型与肺炎克雷伯菌相似，产气克雷伯菌已从肠杆菌属重新分类为克雷伯菌属。目前尚不清楚临床结果是否也更为相似。本研究旨在通过二级数据分析，嵌套于PRO-BAC队列研究，评估产气荚膜克雷伯菌、肺炎克雷伯菌和泄殖腔肠杆菌引起的血流感染（BSI）的临床结局。方法：纳入2016年10月至2017年3月期间因产气荚膜克雷伯菌、肺炎克雷伯菌或泄殖腔肠杆菌引起单微生物BSI的住院患者。主要结果为综合临床结果，包括全因死亡率或随访30天前的复发率。次要结果为发热≥72小时、持续菌血症和二次设备感染。多层次混合效应泊松回归用于估计微生物与结果之间的关联：结果：总共纳入了 29 例产气荚膜杆菌、77 例衣霉菌和 337 例肺炎双球菌 BSI 病例。与丁香杆菌（20.8%）或肺炎双球菌（19.0%）相比，产气荚膜杆菌（6.9%）的死亡率或复发率较低，但未观察到统计学差异（比率比（RR）分别为 0.35，95% CI 0.08 至 1.55；RR 0.42，95% CI 0.10 至 1.71）。在产气荚膜杆菌组中，发热≥72 h和器械感染更为常见。在对混杂因素（年龄、性别、BSI来源、病房、Charlson评分和积极抗生素治疗）进行调整后的多变量分析中，估计值和效应方向与粗略结果相似：结果表明，与丁香杆菌或肺炎双球菌引起的BSI相比，产气荚膜杆菌引起的BSI预后可能更好。
Differences in clinical outcomes of bloodstream infections caused by Klebsiella aerogenes, Klebsiella pneumoniae and Enterobacter cloacae: a multicentre cohort study.
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.
期刊介绍：
Annals of Clinical Microbiology and Antimicrobials considers good quality, novel and international research of more than regional relevance. Research must include epidemiological and/or clinical information about isolates, and the journal covers the clinical microbiology of bacteria, viruses and fungi, as well as antimicrobial treatment of infectious diseases.
Annals of Clinical Microbiology and Antimicrobials is an open access, peer-reviewed journal focusing on information concerning clinical microbiology, infectious diseases and antimicrobials. The management of infectious disease is dependent on correct diagnosis and appropriate antimicrobial treatment, and with this in mind, the journal aims to improve the communication between laboratory and clinical science in the field of clinical microbiology and antimicrobial treatment. Furthermore, the journal has no restrictions on space or access; this ensures that the journal can reach the widest possible audience.
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