Abstract：
OBJECTIVE: Carbapenem-resistant Klebsiella pneumoniae (CRKP) is increasingly being identified in children, but data on the clinical outcomes in this population are limited. This study aimed to characterise the risk factors for 30-day mortality with CRKP bloodstream infection (BSI) in children.
METHODS: A retrospective study was performed from January 2018 to December 2021 at the First Affiliated Hospital of Zhengzhou University. Patients aged < 18 years and 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.
RESULTS: This study 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 appropriately targeted antimicrobial treatment (HR 0.327; 95% CI 0.111-0.969; P = 0.044) were associated with decreased 30-day mortality. Monocyte count < 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.
CONCLUSIONS: Carbapenem-resistant Klebsiella pneumoniae 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.
METHODS: A retrospective study was performed from January 2018 to December 2021 at the First Affiliated Hospital of Zhengzhou University. Patients aged < 18 years and 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.
RESULTS: This study 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 appropriately targeted antimicrobial treatment (HR 0.327; 95% CI 0.111-0.969; P = 0.044) were associated with decreased 30-day mortality. Monocyte count < 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.
CONCLUSIONS: Carbapenem-resistant Klebsiella pneumoniae 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.
摘要：
目的：耐碳青霉烯类肺炎克雷伯菌（CRKP）在儿童中越来越多地被发现，但该人群的临床结局数据有限.这项研究旨在描述儿童CRKP血流感染（BSI）30天死亡的危险因素。
方法：回顾性研究于2018年1月至2021年12月在郑州大学第一附属医院进行。纳入年龄<18岁且具有CRKPBSI的患者。进行多变量Cox和logistic回归以确定CRKP感染后死亡和感染性休克发展的危险因素。分别。
结果：这项研究确定了33名0-4周龄的新生儿和37名年龄较大的儿童。新生儿30天死亡率为39.4%，大龄儿童为43.2%。在新生儿群体中，较高的Pitt菌血症评分(HR1.694;95%CI1.313-2.186;P<0.001)是30天死亡率的独立危险因素.在非新生儿群体中，血小板计数较高（HR0.990；95%CI0.982-0.998；P=0.010），使用碳青霉烯类抗生素(HR0.212;95%CI0.064-0.702;P=0.011)和适当的靶向抗菌治疗(HR0.327;95%CI0.111-0.969;P=0.044)与30天死亡率降低相关.单核细胞计数<0.1×109细胞/L（OR3.615；95％CI1.165-11.444；P=0.026）和较高的Pitt菌血症评分（OR1.330；95％CI1.048-1.688；P=0.019）被确定为发生感染性休克的危险因素。
结论：耐碳青霉烯类肺炎克雷伯菌BSI与儿童高死亡率相关。适当的抗菌治疗对提高生存率很重要,但需要更多的工作来评估儿童特定治疗方案的疗效.
方法：回顾性研究于2018年1月至2021年12月在郑州大学第一附属医院进行。纳入年龄<18岁且具有CRKPBSI的患者。进行多变量Cox和logistic回归以确定CRKP感染后死亡和感染性休克发展的危险因素。分别。
结果：这项研究确定了33名0-4周龄的新生儿和37名年龄较大的儿童。新生儿30天死亡率为39.4%，大龄儿童为43.2%。在新生儿群体中，较高的Pitt菌血症评分(HR1.694;95%CI1.313-2.186;P<0.001)是30天死亡率的独立危险因素.在非新生儿群体中，血小板计数较高（HR0.990；95%CI0.982-0.998；P=0.010），使用碳青霉烯类抗生素(HR0.212;95%CI0.064-0.702;P=0.011)和适当的靶向抗菌治疗(HR0.327;95%CI0.111-0.969;P=0.044)与30天死亡率降低相关.单核细胞计数<0.1×109细胞/L（OR3.615；95％CI1.165-11.444；P=0.026）和较高的Pitt菌血症评分（OR1.330；95％CI1.048-1.688；P=0.019）被确定为发生感染性休克的危险因素。
结论：耐碳青霉烯类肺炎克雷伯菌BSI与儿童高死亡率相关。适当的抗菌治疗对提高生存率很重要,但需要更多的工作来评估儿童特定治疗方案的疗效.
