Risk factors and clinical outcomes of carbapenem-resistant Klebsiella pneumoniae bacteraemia in children: a retrospective study

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is increasingly identified in children, but data on the clinical outcomes in this population are limited. The objectives of this study were to characterize the risk factors for 30-day mortality with CRKP bloodstream infection (BSI) in children. We performed a retrospective study from January 2018 to December 2021 at the First Affiliated Hospital of Zhengzhou University. Patients (<18 years old) with CRKP BSI were included. Multivariable Cox and logistic regression were performed to determine risk factors for death and the development of septic shock following CRKP infection, respectively. We identified 33 neonates aged 0-4 weeks and 37 older children. The 30-day mortality rate was 39.4% in neonates and 43.2% in older children. In the neonatal population, a higher Pitt bacteremia score (HR, 1.694; 95% CI, 1.313-2.186; P <0.001) was an independent risk factor for 30-day mortality. In the non-neonatal population, higher platelet count (HR, 0.990; 95% CI, 0.982-0.998; P = 0.010), the use of carbapenems (HR, 0.212; 95% CI, 0.064-0.702; P = 0.011), and appropriate targeted antimicrobial treatment (HR, 0.327; 95% CI, 0.111-0.969; P = 0.044) were associated with decreased 30-day mortality. Monocyte count less than 0.1 × 109 cells/L (OR, 3.615; 95% CI, 1.165-11.444; P = 0.026), and a higher Pitt bacteremia score (OR, 1.330; 95% CI, 1.048-1.688; P = 0.019) were identified as risk factors for the development of septic shock. CRKP BSI was associated with high mortality in children. Appropriate antimicrobial treatment is important to improve survival, but more work is needed to assess the efficacy of specific treatment regimens in children.