• Hiroki Namikawa, Makoto Niki, Mamiko Niki, Ken-Ichi Oinuma, Koichi Yamada, Kiyotaka Nakaie, Taishi Tsubouchi, Yoshihiro Tochino, Yasuhiko Takemoto, Yukihiro Kaneko, Hiroshi Kakeya, and Taichi Shuto.
• Department of Medical Education and General Practice, Osaka City University, Graduate School of Medicine, 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan. Electronic address: hiroking.nami@gmail.com.
• J Formos Med Assoc. 2022 Apr 1; 121 (4): 848-855.

Background/PurposeKlebsiella pneumoniae bacteremia-induced sepsis is a clinically important condition with a high mortality rate and various known virulence factors. However, studies on the association of these virulence factors with the occurrence of K. pneumoniae bacteremia-induced sepsis are scarce. We aimed to investigate clinical variables and virulence factors in patients with K. pneumoniae bacteremia-induced sepsis.MethodsWe retrospectively reviewed the medical records of 76 patients with K. pneumoniae bacteremia between January 2012 and July 2017. Patients were divided into sepsis (n = 25) and non-sepsis (n = 51) groups. Patient background characteristics, antimicrobial regimens, and prognosis were evaluated. We assessed the distribution of virulence factors related to K. pneumoniae, such as mucoviscosity, capsular polysaccharide, and siderophores. Siderophore production levels were determined by measuring the orange halo zone on chrome azurol S agar plate assay.ResultsThere were no intergroup differences in male-to-female ratio and age. Multivariable analysis revealed that siderophore production level (p < 0.01) was an independent predictor of K. pneumoniae bacteremia-induced sepsis. Furthermore, the optimal cut-off point of siderophore production to predict sepsis was 9.6 mm (sensitivity, 86%; specificity, 76%; AUC, 0.81).ConclusionSiderophore production was an independent predictor of sepsis caused by K. pneumoniae bacteremia. The optimal cut-off point for siderophore production for sepsis occurrence prediction was 9.6 mm. To improve outcomes, patients with K. pneumoniae bacteremia-induced sepsis with high siderophore production levels should be managed prudently.Copyright © 2021 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.

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