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).
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 also suggested 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.”
Logan LK, Nguyen DC, Scaggs Huang FA, et al. A multi-centered case-case-control study of factors associated with Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae infections in children and young adults [published online August 30 2018]. Pediatr Infect Dis J. doi: 10.1097/INF.0000000000002176