Community-acquired Klebsiella pneumoniae pneumonia in ICU: a multicenter retrospective study

Vincent Grosjean; Simon B Gressens; Tài Pham; Stéphane Gaudry; Hafid Ait-Oufella; Nicolas De Prost; Julien Mayaux; Emmanuel Guerot; Véronique Leflon-Guibout; Noémie Mayer; Frédéric Bert; Nathalie Gault; Clément R Massonnaud; Damien Roux

doi:10.1186/s13613-024-01269-3

Community-acquired Klebsiella pneumoniae pneumonia in ICU: a multicenter retrospective study

Ann Intensive Care. 2024 Apr 30;14(1):69. doi: 10.1186/s13613-024-01269-3.

Authors

Vincent Grosjean¹, Simon B Gressens¹, Tài Pham^{2

3}, Stéphane Gaudry⁴, Hafid Ait-Oufella⁵, Nicolas De Prost^{6

7}, Julien Mayaux⁸, Emmanuel Guerot⁹, Véronique Leflon-Guibout¹⁰, Noémie Mayer¹⁰, Frédéric Bert¹⁰, Nathalie Gault¹¹, Clément R Massonnaud^{11

12}, Damien Roux^{13

14}

Affiliations

¹ AP-HP, Service de Médecine Intensive Réanimation, Université Paris Cité, Hôpital Louis Mourier, DMU ESPRIT, 178 Rue des Renouillers, Colombes CEDEX, F-92700, France.
² Service de Medecine Intensive-Réanimation, Hôpital de Bicêtre, Groupe de recherche CARMAS, AP-HP, DMU CORREVE, FHU SEPSIS, Hôpitaux Universitaires Paris-Saclay, Le Kremlin-Bicêtre, France.
³ Université Paris-Saclay, UVSQ, Université Paris-Sud, Inserm U1018, Equipe d'Epidémiologie Respiratoire Intégrative, CESP, Villejuif, F-94807, France.
⁴ Service de Réanimation Médico-Chirurgicale, AP-HP, Hôpital Avicenne, Bobigny, F-93000, France.
⁵ Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, AP-HP, Sorbonne Université, Paris, F-75012, France.
⁶ AP-HP, Hôpital Henri Mondor, Service de Médecine Intensive Réanimation, Créteil, France.
⁷ Université Paris-Est-Créteil (UPEC), INSERM U955, Team « Viruses, Hepatology, Cancer », Créteil, France.
⁸ Service de Médecine Intensive-Réanimation, Département R3S, AP-HP, Groupe Hospitalier Universitaire APHP-Sorbonne Université, Site Pitié-Salpêtrière, Paris, F-75013, France.
⁹ AP-HP, Georges Pompidou European Hospital, Réanimation médicale, Paris, F-75015, France.
¹⁰ Laboratoire de Bactériologie, AP-HP, Hôpital Beaujon, Clichy, France.
¹¹ AP-HP, Hôpital Bichat, Département d'Épidémiologie, Biostatistique et Recherche Clinique, Paris, F-75018, France.
¹² Université Paris Cité, INSERM, IAME, Paris, F-75018, France.
¹³ AP-HP, Service de Médecine Intensive Réanimation, Université Paris Cité, Hôpital Louis Mourier, DMU ESPRIT, 178 Rue des Renouillers, Colombes CEDEX, F-92700, France. damien.roux@aphp.fr.
¹⁴ Université Paris Cité, INSERM, CNRS, Institut Necker-Enfants Malades, Paris, F-75015, France. damien.roux@aphp.fr.

Abstract

Background: Alongside the recent worldwide expansion of hypervirulent Klebsiella pneumoniae (KP) infections, the available literature regarding cases of community acquired pneumonias (KP-CAP) remains scarce but reports a strikingly high and early mortality. We performed a retrospective multicenter study (7 ICU in France) between 2015 and 2019, comparing prognosis and severity of KP-CAP versus Streptococcus pneumoniae - CAP (SP-CAP).

Methods: For each KP-CAP, three SP-CAP admitted in ICUs within the same center and within the same 6-month window were selected. When available, KP strains were studied, and bacterial virulence was genetically assessed for virulence factors. The primary outcome was in-hospital mortality. Associations between clinical outcomes and type of infection were tested using univariate and multivariate logistic regressions, adjusted for pairing variables.

Results: Twenty-seven KP-CAP and 81 SP-CAP were included. Respective in-hospital mortality rates were 59% (n = 16) and 17% (n = 14, p < 0.001), despite adequate antibiotic therapy. KP-CAP median time from admission to death was 26.9 h [IQR 5.75-44 h] and were significantly associated with higher rates of multiple organ failures (93% vs. 42%, p < 0.001), disseminated intravascular coagulation (12% vs. 1.3%, p = 0.046), septic shock (median lactate on ICU admission 4.60 vs. 2.90 mmol/L, p = 0.030) and kidney failure (KDIGO-3: 87% vs. 44%, p < 0.001). Interestingly, alcoholism was the only identified predisposing factor of KP-CAP. Severity on ICU admission (2-fold higher for KP-CAP) was the only factor associated with mortality in a multivariate analysis.

Conclusion: We described a strong association between KP-CAP infection and higher and earlier mortality when compared to SP-CAP. Moreover, alcoholism was the sole predisposing factor associated with KP-CAP infection. These findings should raise awareness of clinicians involved in the management of severe CAP about this microbiological etiology. Future prospective studies are needed to confirm these results and to design strategies to improve the prognosis of such infections.

Keywords: Klebsiella pneumoniae; Streptococcus pneumoniae; Bacterial pneumonia; Community-acquired pneumonia; Hypermuscoviscosity; Prognosis; Virulence.