Patients with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae infections had high multisystem disease / devices burden as well as exposures to carbapenems and aminoglycosides, according to research published in The Pediatric Infectious Disease Journal . Non-ST258 K pneumoniae strains were more common in children, unlike in adults, whereas length of stay and mortality rates were similar across groups
A multicenter case-case-control study of patients age 0 to 22 years was conducted between 2008 and 2015. The case groups were: 1) children with K pneumoniae carbapenemase-producing Enterobacteriaceae infections, 2) patients with carbapenem-susceptible Enterobacteriaceae infections, and 3) the control group who had negative cultures.
Investigators identified 18 K pneumoniae carbapenemase-producing Enterobacteriaceae infections, 2 of which were unrelated non-ST258 K pneumoniae strains. Patients in case groups 1 and 2 had more infections with multidrug-resistant organisms, long-term care facility admissions, and length of stay> 7 days before culture. When compared with controls, those in groups 1 and 2 also had more gastrointestinal comorbidities (odds ratio [OR] 28.0 and 6.4) and> 3 comorbidities (OR 15.4 and 3.5).
Those with K pneumoniae Carbapenemase-producing Enterobacteriaceae had significantly more pulmonary and neurologic comorbidities (both OR 4.4) and gastrointestinal or pulmonary devices (OR 11.4 and 6.1). Those with carbapenem-susceptible Enterobacteriaceae had more previous fluoroquinolone use (OR 7.4) than controls and those with K pneumoniae carbapenemase-producing Enterobacteriaceae had more carbapenem or aminoglycoside use than controls (OR 10.0 and 8.0).
Retrospective study design
Investigators noted that the retrospective study design, a relatively small sample size from a single city, selection bias, and lack of impact generalizability may all be limitations of this study. However, the study does represent "the largest study of K pneumoniae carbapenemase-producing Enterobacteriaceae infections in US pediatric patients to date.
"The results suggest that K pneumoniae carbapenemase-producing Enterobacteriaceae epidemiology is complex and highlight the unique challenges facing control efforts. Investigators suggested that "pediatric carbapenem-resistant Enterobacteriaceae control should focus on modifiable risk factors including antibiotic and device utilization."