Abstract
Relevance. Klebsiella pneumoniae is a major cause of severe healthcare-associated infections in children, representing one of the six most widespread multidrug-resistant microorganisms worldwide and requiring the implementation of population-wide treatment strategies.Aim. To study the risk factors for Klebsiella spread in pediatric healthcare settings.Materials and Methods. Here we performed a descriptive retrospective epidemiological study of Klebsiella spp. cases in pediatric units across the entire Kemerovo region (2012–2019). In total, we documented 27,852 treatment outcomes. We further selected 52 confirmed cases and assessed their risk profiles in comparison with 738 condition-matched control children.Results. Average incidence of Klebsiella spp. detection in pediatric healthcare settings was 78.52 per 1,000 patients (95% CI = 75.42–81.74). We revealed a declining incidence of Klebsiella pneumoniae infection in the region, with notable 4-year cyclicity. The proportion of Klebsiella pneumoniae-infected patients increased 2-fold after 5 days of antibiotic therapy. Among the risk factors of Klebsiella pneumonia infection were artificial feeding (OR = 9,21, 95% = 3,31–35,45, р = 0,0001), assisted ventilation (OR = 7,36, 95% CI = 3,92–14,0], р = 0,0001), use of nebulizers (OR = 5,34, 95% CI =2,49 – 10,9], р=0,0001), airway management (OR = 4,62, 95% CI =2,49–8,56, р = 0,0001), preterm birth (OR = 2,55, 95% CI =1,38 – 4,69, р=0,001), low body weight (OR = 2,48, 95% CI = 1,34–4,56, р = 0,002), enema administration (OR = 1,80, 95% CI = 0,78–3,81, р = 0,088), and nasogastric intubation (OR = 1,79, 95% CI = 0,85–3,54, р = 0,065).Conclusions. The incidence of Klebsiella pneumoniae infections is currently lowering and has 4-year cyclicity. Antimicrobial treatment is associated with 2-fold increased risk if administered for ≥ 5 days. A number of healthcare-associated risk factors of Klebsiella pneumoniae infections have been found.
Highlights
Материалы и методы Выполнено описательное ретроспективное сплошное эпидемиологическое исследование случаев инфицирования бактериями рода Klebsiella в медицинских организациях Кемеровской области в 2012–2019 гг
Average incidence of Klebsiella spp. detection in pediatric healthcare settings was 78.52 per 1,000 patients
Кемерово и Кемеровской области за 2012–2019 гг
Summary
Факторы риска инфицирования Klebsiella pneumoniae пациентов детских медицинских организаций. Изучение факторов риска инфицирования Klebsiella pneumoniae пациентов детских медицинских организаций. Изучены исходы лечения 27 852 пациентов, у 2187 из которых выявлены Klebsiella spp. Выявлены факторы высокого риска инфицирования пациентов K. pneumoniae: искусственное вскармливание (OR = 9,21, 95% ДИ = 3,31–35,45, р = 0,0001), искусственная вентиляция легких (OR = 7,36, 95% ДИ = 3,92– 14,09, р = 0,0001), ингаляции через небулайзер (OR = 5,34, 95% ДИ = 2,49–10,90, р = 0,0001), санация верхних дыхательных путей (OR = 4,62, 95% ДИ =2,49–8,56, р = 0,0001), малый срок гестации (OR = 2,55, 95% ДИ =1,38–4,69, р = 0,001), недостаток массы тела (OR = 2,48, 95% ДИ = 1,34–4,56, р = 0,002), постановка очистительной клизмы (OR = 1,80, 95% ДИ = 0,78–3,81, р = 0,088), зондирование желудка (OR = 1,79, 95% ДИ = 0,85–3,54, р = 0,065). Ключевые слова: Klebsiella pneumoniae, частота, инфекции, связанные с оказанием медицинской помощи, факторы риска, чувствительность к антимикробным препаратам Конфликт интересов не заявлен. Б. Факторы риска инфицирования Klebsiella pneumoniae пациентовдетских медицинских организаций. Risk Factors of Klebsiella pneumoniae Infections in Pediatric Healthcare Settings SA Kuzmenko**1, 2, MA Shmakova, EB Brusina Kemerovo State Medical University, Ministry of Health of the Russian Federation, Kemerovo, Russia 2 Belyaev Kemerovo Regional Clinical Hospital, Russian Federation
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