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Published on: February 9, 2011
Retrospective Case-Control Study of Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection in Children
Caizhen Wang1, Lijie Feng1, Ruomu Chen2
1Pediatric Intensive Care Unit, The Second Hospital of Hebei Medical University, Shijiazhuang 050050, China.
Insights
Hematopoietic malignancies and mechanical ventilation increase carbapenem-resistant Klebsiella pneumoniae (CRKP) infection risk in children. Close monitoring is vital for CRKP patients with bloodstream infections and low white blood cell counts.
Area of Science:
- Infectious Diseases
- Pediatric Medicine
- Microbiology
Background:
- Carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a significant threat to hospitalized children.
- Understanding risk factors for CRKP infection and mortality is crucial for effective clinical management.
Purpose of the Study:
- To identify risk factors for CRKP infection in children.
- To analyze factors associated with mortality in pediatric CRKP cases.
- To develop a predictive model for CRKP infection in children.
Main Methods:
- Retrospective case-control study design.
- Inclusion of 153 carbapenem-sensitive K. pneumoniae cases and 49 CRKP cases.
- Logistic regression analysis for risk factor identification and mortality analysis.
Main Results:
- Hematopoietic malignancies, mechanical ventilation, and multiple antibiotic agents were significant risk factors for CRKP infection.
- Lower white blood cell and neutrophil counts were associated with CRKP infection.
- Bloodstream infections and decreased WBC/lymphocyte counts indicated a poor prognosis in CRKP-infected children.
Conclusions:
- Hematopoietic malignancies, non-respiratory infections, mechanical ventilation, and polypharmacy are key factors for CRKP infection in children.
- Children with CRKP, particularly those with bloodstream infections and low neutrophil counts, require close monitoring.
- Early identification of risk factors can aid in preventing and treating CRKP infections in pediatric populations.
Abstract:
This study aims to investigate the risk factors for infection and mortality associated with carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitalized children, with the goal of providing valuable insights for the prevention and treatment of these bacterial infections. A retrospective case-control study was conducted, including 153 cases of carbapenem-sensitive K. pneumoniae infection in children and 49 cases of CRKP infection. Among the CRKP cases, 40 children survived and nine died. Logistic regression analysis was used to screen the risk factors for CRKP infection in children, establish a predictive model, and analyze the factors associated with mortality in CRKP-infected children. The results of the multivariate regression analysis showed that hematopoietic malignancies (OR = 28.272, 95% CI: 2.430-328.889), respiratory tract infections (OR = 0.173, 95% CI: 0.047-0.641), mechanical ventilation (OR = 3.002, 95% CI: 1.117-8.071), number of antibiotic agents (OR = 1.491, 95% CI: 1.177-1.889), WBC (OR = 0.849, 95% CI: 0.779-0.926), and neutrophil count (OR = 0.779, 95% CI: 0.677-0.896) were identified as significant factors associated with CRKP infection in children. Specifically, CRKP-infected children with a history of multiple hospitalizations within the past three months, blood stream infections, and decreased WBC and lymphocyte counts should be monitored closely due to poor prognosis. Underlying hematopoietic malignancies in children, non-respiratory tract infections, mechanical ventilation after admission, and use of multiple antibiotics without significant increase in white blood cell and neutrophil counts are major factors influencing CRKP infection. Particularly, CRKP-infected children with blood stream infections and no significant increase in neutrophil count should be closely monitored for potential severity of illness.
