• Vol. 36 No. 8, 642–646
  • 15 August 2007

Adverse Hospital Outcomes Associated With the Choice of Empiric Antibiotics in Klebsiella pneumoniae Pneumonia: A Retrospective Observational Study



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Introduction: In Malaysia, Klebsiella pneumoniae ranks high as a cause of adult pneumonia requiring hospitalisation. Patients and Methods: With concern over its rising microbial resistance, we explored the association of empiric antibiotics choices with the hospital outcomes of patients treated for microbial proven K. pneumoniae pneumonia in an urban-based teaching hospital. Results: In 313 eligible cases reviewed retrospectively, hospital mortality and requirement for ventilation were 14.3% and 10.8% respectively. Empiric regimes that had in vitro resistance to at least one empiric antibiotic (n = 90) were associated with higher hospital mortality (23.3% vs. 10.8%, P = 0.004) with risk increased by about two-fold [Odds ratio (OR), 2.5; 95% confidence interval (CI), 1.3 to 4.8]. Regimes (n = 84) other than the commonly recommended “standard” regimes (a β-lactam stable antibiotic with or without a macrolide) were associated with higher ventilation rates (16.7% vs. 8.8%, P = 0.047) with similar increased risk [OR, 2.0; 95% CI, 1.0 to 4.3]. Conclusions: Our findings reiterate the clinical relevance of in vitro microbial resistance in adult K. pneumoniae pneumonia and support empiric regimes that contain β-lactam stable antibiotics.

Klebsiella pneumoniae ranks high as a cause of community-acquired pneumonia (CAP) in hospitalised patients in Malaysia.1-3 This appears unique, as most reports from other countries including Thailand4 do not always share this finding. Studies from Singapore have shown that K. pneumoniae is important in severe CAP requiring hospitalisation,5 not in CAP per se.6 The morbidity and mortality caused by K. pneumoniae infections, and particularly the extended-spectrum β-lactamases (ESBLs) producing organisms, are high,7-9 and appropriate anti-microbial therapy is crucial in determining clinical outcomes.10

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