Nosocomial Klebsiella pneumoniae bacteraemia in adult cancer patients--characteristics of neutropenic and non-neutropenic patients

Abstract

Background: Neoplastic diseases are common in patients with nosocomial Klebsiella pneumoniae bacteraemia. This study investigated the clinical characteristics of neutropenic and non-neutropenic adult cancer patients with nosocomial K. pneumoniae bacteraemia.

Methods: Adult cancer patients with K. pneumoniae bacteraemia were retrospectively analyzed at a medical centre in northern Taiwan over a 3-y period. We compared clinical characteristics of cancer patients with nosocomial K. pneumoniae bacteraemia between neutropenic and non-neutropenic groups and identified risk factors for 14-day mortality.

Results: Of the 189 patients recruited, 49 (26%) had neutropenia. Haematological malignancies, advanced cancer stage, chemotherapy treatment within 1 month and unknown origin of bacteraemia were predominant among patients with neutropenia. Patients without neutropenia tended to be older, tended to have solid tumours and tended to have bacteraemia of biliary origin. The overall 14-day mortality rate was 25.4%. There was no significant difference in 14-day mortality rate between patients with neutropenia (24.5%) and those without neutropenia (25.7%) (p = 0.808). The duration and severity of neutropenia, administration of inadequate empirical antibiotics and presence of extended-spectrum β-lactamase-producing strains were not risk factors for mortality due to nosocomial K. pneumoniae. Multivariate analysis showed that septic shock was the only independent risk factor for mortality.

Conclusions: Nosocomial bacteraemia due to K. pneumoniae in patients with malignancies had heterogeneous characteristics between neutropenic and non-neutropenic groups. Cancer patients in both groups have a poor prognosis. More attention should be paid to cancer patients with nosocomial bacteraemia due to K. pneumoniae despite treatment with adequate antibiotics.