Clinical Characteristics Of Carbapenem Resistant Enterobacteriaceae Bloodstream Infection: A Retrospective Study Among Children

Purpose: The clinical features and treatment of Carbapenem resistant Enterobacteriaceae（CRE）bacteremia among children were different from the adults. Clinical studies about CRE infection among children was still lack of enough samples. The aim of this study was to share our experience of diagnosis and treatment of CRE bacteremia and to improve the prognosis of children infected with CRE. Methods: : Clinical records were systematically reviewed to extract the detailed information and treatment results. Potential risk factors for infection mortality were examined by a case-control study. Case-patients were those who died from the BSI and control-patients those who survived. Data were analyzed to explore the difference of clinical characteristics resulted from CRE infection between neonate and non-neonate group and more appropriate treatment strategy by using SPSS 23.0. Results: A total of 36 CRE BSI were collected from January 2016 to December 2019, including 21 neonates and 15 non-neonates. The mortality due to CRE infection was 25%. K.pneumoniae (22, 61.1%) was the main pathogen. Patients suffered from different clinical manifestions, including fever(24, 66.7%), Breath holding spell(13, 36.1%), Sepsis（11, 30.6%）, MODS(6, 16.7%), digestive tract symptom(15, 41.6%). The incidence of breath holding spell was higher among newborn group(P<0.05) while the incidence of sepsis was higher among non-neonate group(P<0.05). There was no difference of percentage of underlying diseases between survival group and non-survial group. Combination therapy shown a significant reduction of mortality (P<0.05). Conclusion: Klebsiella.Pneumoniae was the most common isolates among children CRE BSI .Monotherapy maybe appropriate for neonates for those with slightly clinical manifestation resulted from CRE BSI while combination therapy are more effective and could give rise to significant reduction of mortality among children.