Clinical, Laboratory and Prognostic Features of Nosocomial Infections Caused by Carbapenemase-producing Klebsiella pneumoniae in Pediatric Patients

BACKGROUND: Carbapenemase-producing Klebsiella pneumoniae (CPKP) is a major cause of nosocomial infections in children, with high mortality. This study compared clinical features and outcomes between CPKP and carbapenem-susceptible K. pneumoniae (CSKP) infections in pediatric patients and identified independent risk factors for carbapenem resistance. METHODS: This retrospective cohort study included pediatric patients with confirmed K. pneumoniae infections at a university hospital. Patients were categorized into CPKP and CSKP groups. Data on demographics, clinical features and laboratory results were analyzed. Univariate and multivariate logistic regression analyses were performed to identify risk factors for carbapenem resistance. RESULTS: The CPKP group had significantly higher 30-day mortality (29.7% vs. 13.0%, P = 0.019), longer hospital stay (14 vs. 10 days, P < 0.001) and prolonged intensive care unit stay (3 vs. 0 days, P < 0.001) compared to CSKP. CRP levels were significantly elevated in CPKP patients (141 vs. 51 mg/L, P < 0.001), with a cutoff of 110 mg/L showing moderate predictive value (area under the curve: 0.699). Multivariate analysis identified prior fluoroquinolone use (odds ratio [OR]: 3.09, 95% confidence interval [CI]: 1.22-7.83), previous CPKP colonization/infection (OR: 7.89, 95% CI: 2.92-21.36), recent surgery (OR: 4.76, 95% CI: 1.89-12.02) and inotropic support requirement (OR: 3.27, 95% CI: 1.21-8.83) as independent risk factors. Chemotherapy, immunotherapy, use of invasive devices other than central venous catheters, polymicrobial sepsis, underlying illnesses and site or type of infection were evaluated but did not show a statistically significant association with carbapenem resistance. CONCLUSIONS: CPKP infection in pediatric patients was associated with poor outcomes and was independently related to prior fluoroquinolone use, recent surgery, previous CPKP colonization or infection, and illness severity.