Invasive Klebsiella Pneumoniae Infections in Pediatric Patients

Abstract Objective: To assess clinical characteristics, outcomes and antimicrobial resistance of invasive Klebsiella pneumoniae (KP) infections in Chinese pediatric patients in hospital and community settings. Methods: This retrospective study was conducted in the nine tertiary hospitals during 2016-2018. The eligible pediatric inpatients who had KP isolated from blood and cerebrospinal fluid and had complete medical records reviewed were included. We compared the clinical characteristics, outcomes and antimicrobial resistance between community-acquired infections (CAI) and healthcare-associated infections (HAI), neonates and children old than 28 days, and carbapenem-resistant KP (CRKP) and carbapenem-sensitive KP (CSKP) infections. Result: In a total of enrolled 324 patients, 275 (84.9%) were clinically defined as HAI; 188 (58.0%) were neonates and 175 (93.5%) were attributable to HAI. The prevalence of CRKP was 35.8% (40.4% in HAI verse 10.2% in CAI, P <0.05). Hematologic malignancies (odds ratio (OR):15.52, 95% CI:1.89-127.14), prematurity (OR:37.07, 95% CI:8.29-165.84), invasive mechanical ventilation (OR:13.09, 95% CI: 1.66-103.56) were independent risk factors for HAI. Patients from rural area (OR: 2.05, 95% CI:1.22-3.43), invasive mechanical ventilation (OR:2.06, 95% CI: 1.13-3.76), previous antibiotic therapy (OR: 2.07, 95% CI:1.17-3.68) and previous hospital stay (OR: 2.18, 95% CI:1.18-4.03) were found to be associated with CRKP infections. Organ dysfunction was independently correlated with poor outcomes (OR: 2.88, 95% CI:1.25-6.60). Conclusions: Most of KP infections were healthcare-associated and the prevalence of invasive CRKP infections was high in pediatric patients in China. The continuous efforts of strengthening infection prevention control interventions are needed to reduce the health burden of severe KP infections in Chinese children.