Community-acquired Klebsiella pneumoniae complicated skin and soft-tissue infections of extremities: Emphasis on cirrhotic patients and gas formation

Chia-Ming Chang, H. C. Lee, Nan-Yao Lee, I. W. Lee, C. J. Wu, Po-Lin Chen, C. C. Lee, Nai-Ying Ko, Wen-Chien Ko

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31 Citations (Scopus)

Abstract

Background: Klebsiella pneumoniae was rarely reported to cause complicated skin and soft tissue infections (cSSTIs). Our study was to delineate clinical characteristics and outcome of cSSTIs involving extremities caused by K. pneumoniae. Patients and Methods: Adult patients aged 16 years or more with community-acquired cSSTIs, which involved the extremities and were caused by four common aerobic pathogens at a medical center in southern Taiwan during a 54-month period, were reviewed. Results: Of 76 cases enrolled, Staphylococcus aureus was the most common pathogen (52 cases, 68%), followed by K. pneumoniae (16, 21%), β-hemolytic streptococci (5, 7%), and Escherichia coli (3, 4%). Forty-six (61%) had underlying conditions, and diabetes mellitus was most common among K. pneumoniae and non-K. pneumoniae groups (63% and 45%, respectively). Compared to patients with cSSTIs caused by other bacteria, those with K. pneumoniae cSSTIs were predominantly male, more often had liver cirrhosis, malignant neoplasm and alcoholism. In addition, they were more likely to have fever, shock, bacteremia, gas formation, pyomyositis, metastatic infections, as well as longer durations of hospitalization. Using multivariate analysis, liver cirrhosis (adjusted odds ratio [aOR] 12.5, 95% confidence interval [CI] 2.0-79.1, p = 0.007) and male gender (aOR 11.5, 95% CI 1.1-116.8, p = 0.039) were significantly associated with K. pneumoniae cSSTIs. Conclusions: We highlight the role of K. pneumoniae in Taiwanese patients with cSSTIs involving extremities, and its potential for gas and pus formation, and metastatic infections. Empiric antimicrobial coverage of K. pneumoniae and close monitoring of metastatic infections are mandatory for patients with risk factors.

Original languageEnglish
Pages (from-to)328-334
Number of pages7
JournalInfection
Volume36
Issue number4
DOIs
Publication statusPublished - 2008 Aug 1

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Soft Tissue Infections
Klebsiella pneumoniae
Extremities
Gases
Skin
Liver Cirrhosis
Infection
Odds Ratio
Pyomyositis
Confidence Intervals
Suppuration
Bacteremia
Streptococcus
Taiwan
Alcoholism
Staphylococcus aureus
Shock
Pneumonia
Diabetes Mellitus
Hospitalization

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

@article{96d7ecb2371244059505e97537e117ac,
title = "Community-acquired Klebsiella pneumoniae complicated skin and soft-tissue infections of extremities: Emphasis on cirrhotic patients and gas formation",
abstract = "Background: Klebsiella pneumoniae was rarely reported to cause complicated skin and soft tissue infections (cSSTIs). Our study was to delineate clinical characteristics and outcome of cSSTIs involving extremities caused by K. pneumoniae. Patients and Methods: Adult patients aged 16 years or more with community-acquired cSSTIs, which involved the extremities and were caused by four common aerobic pathogens at a medical center in southern Taiwan during a 54-month period, were reviewed. Results: Of 76 cases enrolled, Staphylococcus aureus was the most common pathogen (52 cases, 68{\%}), followed by K. pneumoniae (16, 21{\%}), β-hemolytic streptococci (5, 7{\%}), and Escherichia coli (3, 4{\%}). Forty-six (61{\%}) had underlying conditions, and diabetes mellitus was most common among K. pneumoniae and non-K. pneumoniae groups (63{\%} and 45{\%}, respectively). Compared to patients with cSSTIs caused by other bacteria, those with K. pneumoniae cSSTIs were predominantly male, more often had liver cirrhosis, malignant neoplasm and alcoholism. In addition, they were more likely to have fever, shock, bacteremia, gas formation, pyomyositis, metastatic infections, as well as longer durations of hospitalization. Using multivariate analysis, liver cirrhosis (adjusted odds ratio [aOR] 12.5, 95{\%} confidence interval [CI] 2.0-79.1, p = 0.007) and male gender (aOR 11.5, 95{\%} CI 1.1-116.8, p = 0.039) were significantly associated with K. pneumoniae cSSTIs. Conclusions: We highlight the role of K. pneumoniae in Taiwanese patients with cSSTIs involving extremities, and its potential for gas and pus formation, and metastatic infections. Empiric antimicrobial coverage of K. pneumoniae and close monitoring of metastatic infections are mandatory for patients with risk factors.",
author = "Chia-Ming Chang and Lee, {H. C.} and Nan-Yao Lee and Lee, {I. W.} and Wu, {C. J.} and Po-Lin Chen and Lee, {C. C.} and Nai-Ying Ko and Wen-Chien Ko",
year = "2008",
month = "8",
day = "1",
doi = "10.1007/s15010-008-7272-3",
language = "English",
volume = "36",
pages = "328--334",
journal = "Infection",
issn = "0300-8126",
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TY - JOUR

T1 - Community-acquired Klebsiella pneumoniae complicated skin and soft-tissue infections of extremities

T2 - Emphasis on cirrhotic patients and gas formation

AU - Chang, Chia-Ming

AU - Lee, H. C.

AU - Lee, Nan-Yao

AU - Lee, I. W.

AU - Wu, C. J.

AU - Chen, Po-Lin

AU - Lee, C. C.

AU - Ko, Nai-Ying

AU - Ko, Wen-Chien

PY - 2008/8/1

Y1 - 2008/8/1

N2 - Background: Klebsiella pneumoniae was rarely reported to cause complicated skin and soft tissue infections (cSSTIs). Our study was to delineate clinical characteristics and outcome of cSSTIs involving extremities caused by K. pneumoniae. Patients and Methods: Adult patients aged 16 years or more with community-acquired cSSTIs, which involved the extremities and were caused by four common aerobic pathogens at a medical center in southern Taiwan during a 54-month period, were reviewed. Results: Of 76 cases enrolled, Staphylococcus aureus was the most common pathogen (52 cases, 68%), followed by K. pneumoniae (16, 21%), β-hemolytic streptococci (5, 7%), and Escherichia coli (3, 4%). Forty-six (61%) had underlying conditions, and diabetes mellitus was most common among K. pneumoniae and non-K. pneumoniae groups (63% and 45%, respectively). Compared to patients with cSSTIs caused by other bacteria, those with K. pneumoniae cSSTIs were predominantly male, more often had liver cirrhosis, malignant neoplasm and alcoholism. In addition, they were more likely to have fever, shock, bacteremia, gas formation, pyomyositis, metastatic infections, as well as longer durations of hospitalization. Using multivariate analysis, liver cirrhosis (adjusted odds ratio [aOR] 12.5, 95% confidence interval [CI] 2.0-79.1, p = 0.007) and male gender (aOR 11.5, 95% CI 1.1-116.8, p = 0.039) were significantly associated with K. pneumoniae cSSTIs. Conclusions: We highlight the role of K. pneumoniae in Taiwanese patients with cSSTIs involving extremities, and its potential for gas and pus formation, and metastatic infections. Empiric antimicrobial coverage of K. pneumoniae and close monitoring of metastatic infections are mandatory for patients with risk factors.

AB - Background: Klebsiella pneumoniae was rarely reported to cause complicated skin and soft tissue infections (cSSTIs). Our study was to delineate clinical characteristics and outcome of cSSTIs involving extremities caused by K. pneumoniae. Patients and Methods: Adult patients aged 16 years or more with community-acquired cSSTIs, which involved the extremities and were caused by four common aerobic pathogens at a medical center in southern Taiwan during a 54-month period, were reviewed. Results: Of 76 cases enrolled, Staphylococcus aureus was the most common pathogen (52 cases, 68%), followed by K. pneumoniae (16, 21%), β-hemolytic streptococci (5, 7%), and Escherichia coli (3, 4%). Forty-six (61%) had underlying conditions, and diabetes mellitus was most common among K. pneumoniae and non-K. pneumoniae groups (63% and 45%, respectively). Compared to patients with cSSTIs caused by other bacteria, those with K. pneumoniae cSSTIs were predominantly male, more often had liver cirrhosis, malignant neoplasm and alcoholism. In addition, they were more likely to have fever, shock, bacteremia, gas formation, pyomyositis, metastatic infections, as well as longer durations of hospitalization. Using multivariate analysis, liver cirrhosis (adjusted odds ratio [aOR] 12.5, 95% confidence interval [CI] 2.0-79.1, p = 0.007) and male gender (aOR 11.5, 95% CI 1.1-116.8, p = 0.039) were significantly associated with K. pneumoniae cSSTIs. Conclusions: We highlight the role of K. pneumoniae in Taiwanese patients with cSSTIs involving extremities, and its potential for gas and pus formation, and metastatic infections. Empiric antimicrobial coverage of K. pneumoniae and close monitoring of metastatic infections are mandatory for patients with risk factors.

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U2 - 10.1007/s15010-008-7272-3

DO - 10.1007/s15010-008-7272-3

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VL - 36

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JO - Infection

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SN - 0300-8126

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