Invasive Klebsiella pneumoniae Infections in Community-Settings and Healthcare Settings

Abstract

To assess clinical characteristics, outcomes and antimicrobial resistance of invasive Klebsiella pneumoniae (KP) infections in Chinese pediatric patients in hospital and community settings. 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. Results: 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 38.2% (43.4% in HAI verse 8.7% 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: 1.94, 95% CI: 1.12-3.35), invasive mechanical ventilation (OR: 2.33, 95% CI: 1.25-4.33), antibiotic therapy prior to admission (OR: 2.33, 95% CI: 1.25-4.33) and prior hospital stay in the past 30 days (OR: 3.46, 95% CI: 1.87-6.41) were associated with healthcare-associated CRKP infections. Organ dysfunction was independently correlated with poor outcomes (OR: 2.92, 95% CI: 1.23-6.95). Conclusion:Pediatric invasive KP infections and high prevalence of CRKP infections largely occurred in healthcare settings in China. The adequate and intensified infection control measures should be focused on high-risk hematologic patients, neonatal patients and intubated patients.

Surveillance of carbapenem-resistant Klebsiella pneumoniae in a paediatric hospital in China revealed the dynamics of carbapenemase and the prevalence of ST2735 K. pneumoniae

“…In our study, all infections were healthcare-associated, implying serious nosocomial CRKP infections in paediatric patients, consistent with other studies [27, 28]. The age of our patients was relatively low compared with other studies, and most of our specimens were blood and pleural effusion and ascites.…”

Prevalence of Multidrug-Resistant Klebsiella pneumoniae Clinical Isolates in Nepal

“…K . pneumoniae has emerged as a major clinical and public health problem due to the rising prevalence of the infections caused by emerging multidrug-resistant strains [ 6 , 7 , 12 ].…”

Klebsiella invasive syndrome: a challenging diagnosis

“…A hypervirulent strain of the bacterium causes the invasive Klebsiella syndrome, which is a less-commonly encountered clinical entity and has been described to have varied presentations. There have been incidences of Klebsiella pneumoniae invasive syndrome (KPIs)1 that started as a primary liver abscess2–4 with dissemination to the meninges and endophthalmitis, described in East Asia. There are around 20 case reports of this syndrome described in the USA, however, the incidence is on the rise.…”