Abstract
BACKGROUND: In recent years, the spread of carbapenemase in Klebsiella pneumoniae (K. pneumoniae) has led to an increase in the prevalence of carbapenem-resistant Enterobacteriaceae (CRE). However, infection caused by CRE is associated with high mortality, and the treatment options are limited. Therefore, reducing CRE infection and mortality has become a critical aim in public health. The prevalence of CRE infections is increasing in China. However, few studies have addressed its epidemiology in infants. This study aimed to investigate the risk factors for death from bloodstream infections of carbapenem-resistant K. pneumoniae (CRKP) in infants in the pediatric intensive care unit (PICU) in order to develop effective prevention strategies to reduce its prevalence. METHODS: A total of 42 infants with CRKP bloodstream infection who were admitted or transferred to the PICU of Xinhua Hospital Affiliated to Shanghai Jiaotong University from January 1, 2017, to December 30, 2019, were included in the study, and their demographic characteristics, basic clinical data, invasive procedures, infection indicators, and other relevant data were analyzed. RESULTS: Among the 45 CRE bloodstream infections, CRKP accounted for 93.3% (42/45) and carbapenem-resistant Escherichia coli (CREC) accounted for 6.7% (3/45). There were 42 infants with CRKP bloodstream infection, including 25 males and 17 females, with a median age of 45 [interquartile range (IQR), 1-150] days and a PICU hospital stay of 32 (IQR, 16.8-53.8) days. Among them, 12 (28.6%) died (death group) and 30 (71.4%) survived (survival group). Univariate analysis showed that gestational age, low body weight, parenteral nutrition, surgery, central venous catheterization, endotracheal intubation, antibiotic glycopeptides, and fosfomycin use were all risk factors for mortality from CRKP bloodstream infection in infants. Multivariate regression analysis showed that gestational age and surgery were independent risk factors for mortality from CRKP bloodstream infection in infants. CONCLUSIONS: Prevention and control measures should be formulated for the risk factors for mortality from CRKP bloodstream infections in infants, the management process for invasive procedures should be strengthened, and the use of antimicrobial drugs should be controlled to improve prognosis.