Healthcare-associated Invasive Klebsiella Pneumoniae Infections in Chinese Pediatric Patients: Risk Factors, Outcomes and Antimicrobial Resistance

Background: High prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a serious clinical concern in China. This study first described the risk factors, outcomes and antimicrobial resistance pattern of healthcare-associated KP infections in Chinese pediatric patients. Methods: : This retrospective study was conducted in the nine tertiary hospitals during 2016-2018. The 324 pediatric inpatients who had KP isolated from blood and cerebrospinal fluid and had complete medical records reviewed were included. We analyzed the risk factors, outcomes and antimicrobial resistance pattern of KP-infected patients based on comparison between healthcare-associated KP infections (HAI) and community-acquired infections. Result: Of the 324 enrolled patients, 275 (84.9%) were clinically defined as HAI, including 175 (63.6%) neonates and 100 (36.4%) aged >28 days. The overall prevalence of CRKP was 35.8% (40.4% in HAI verse 10.2% in CAI, P <0.05). Prematurity (odds ratio (OR):37.07, 95% CI:8.29-165.84), hematologic malignancies (OR:15.52, 95% CI:1.89-127.14) and invasive mechanical ventilation (OR:13.09, 95% CI: 1.66-103.56) were independent risk factors for HAI. Patients from rural area (OR: 1.78, 95% CI:1.06-2.99), invasive mechanical ventilation (OR:1.79, 95% CI: 1.01-3.19), antibiotic therapy prior to admission (OR: 1.88, 95% CI:1.07-3.29) and prior hospital stay in the past 30 days (OR: 2.17, 95% CI:1.26-3.73) were associated with healthcare-associated CRKP infections. Organ dysfunction was independently correlated with poor outcomes (OR:2.92, 95% CI: 1.23-6.95) Conclusions: : Pediatric invasive KP infections and high prevalence of CRKP infections largely occurred in health-care settings in China. The adequate and intensified infection control measures should be focused on high-risk hematologic patients, neonatal patients and intubated patients.