Abstract
BackgroundBloodstream infections (BSI) caused by carbapenem-resistant K. pneumoniae (CRKP) are associated with high rates of morbidity and mortality. Early identification of patients at highest risk is very important. The aim of this study was to describe the clinical characteristics and mortality of K. pneumoniae BSI and to identify risk factors associated with CRKP BSI among paediatric patients.MethodsFrom January 2011 to December 2014, a retrospective case-control study was conducted at Beijing Children’s Hospital, China. Risk factors for CRKP BSI and for K. pneumoniae BSI-related death were evaluated. Patients with BSI caused by K. pneumoniae were identified from the microbiology laboratory database. Data regarding demographic, microbiological and clinical characteristics, therapy and outcome were collected from the medical records.ResultsA total of 138 patients with K. pneumoniae BSI were enrolled, including 54 patients with CRKP BSI and 84 patients with carbapenem-susceptible K. pneumoniae (CSKP) BSI. Most of the BSI (114; 82.6%) were healthcare-associated, while the rest (24; 17.4%) were community-acquired. Hematologic malignancies (odds ratio (OR):4.712, [95% CI: 2.181–10.180], P < 0.001) and previous cephalosporin administration (OR: 3.427, [95% CI: 1.513–7.766], P = 0.003) were found to be associated with the development of CRKP BSI. 28-day mortality of K. pneumoniae BSI was 8.7%. Mechanical ventilation (OR:9.502, [95% CI: 2.098–43.033], P = 0.003), septic shock (OR:6.418, [95% CI: 1.342–30.686], P = 0.020), and isolation of CRKP (OR:9.171, [95% CI: 1.546–54.416], P = 0.015) were independent risk factors for 28-day mortality of K. pneumoniae BSI.ConclusionHematologic malignancies and previous cephalosporin administration were associated with the development of CRKP BSI, while mechanical ventilation, septic shock and CRKP infection were independent mortality predictors for K. pneumoniae BSI. More attention should be paid to CRKP BSI in the paediatric population.
Highlights
Bloodstream infections (BSI) caused by carbapenem-resistant K. pneumoniae (CRKP) are associated with high rates of morbidity and mortality
Characteristics of patients We identified a total of 161 unique cases of bloodstream infections with K. pneumoniae during the study period
In China, the main factor causing carbapenem resistance was KPC-2 among adults [23]; NDM-1- producing K. pneumoniae was most common in children [21]
Summary
Bloodstream infections (BSI) caused by carbapenem-resistant K. pneumoniae (CRKP) are associated with high rates of morbidity and mortality. The aim of this study was to describe the clinical characteristics and mortality of K. pneumoniae BSI and to identify risk factors associated with CRKP BSI among paediatric patients. Carbapenem resistant K. pneumoniae (CRKP) has spread worldwide, including to China [1, 2]. This organism is rapidly becoming a major threat to public health because of the limited therapeutic options and the high morbidity and mortality. Bloodstream infection (BSI) is the most important infection, with a high risk of mortality [10]. With broad-spectrum antibiotic resistance, treatment options for BSI caused by CRKP are very limited [11, 12]
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