The Epidemiology of Nosocomial Infections Caused byKlebsiella pneumoniae

Klebsiella pneumoniae causes serious epidemic and endemic nosocomial infections. We conducted a literature review to characterize the epidemiology of epidemic K. pneumoniae outbreaks. Eighty percent of the outbreaks (20/25) involved infections of the bloodstream or urinary tract. Person-to-person spread was the most common mode of transmission, and nearly 50% of the outbreaks occurred in neonatal intensive care units. No one serotype predominated, and no association was found between serotype and either the site of infection or antimicrobial susceptibility pattern. We used data reported to the Centers for Disease Control (CDC) by hospitals participating in the National Nosocomial Infections Study (NNIS) to describe the epidemiology of endemic K. pneumoniae infections. In the 8-year period from 1975 through 1982 the nosocomial K. pneumoniae infection rate was 16.7 infections per 10,000 patients discharged. The rate of infection at medical school-affiliated hospitals was significantly greater than at nonaffiliated hospitals; furthermore, the rate of infection at large affiliated hospitals was greater than at small affiliated hospitals. The rate of infection varied by service, with the highest rate found on the medicine service. During the 8-year period, 184 deaths were caused by nosocomial K. pneumoniae infections (184 deaths/16,969 infections, case-fatality ratio 1.1%), with higher ratios in pediatrics (5%) where there was a 12% mortality in children infected with an aminoglycoside-resistant strain.