Methods: We conducted a retrospective case-control study in patients aged 0 - 22 years. Cases were defined as patients with infections phenotypically identified as KPC. Controls were patients during the same time period with carbapenem susceptible Enterobacteriaceae infections. Cases and controls were 1:1 matched by age. Chi-squared analysis was performed.
Results: We identified 18 KPC-producing Enterobacteriaceae infections. The median patient age was 16.8 years, 33% were African-American, 67% were in an ICU setting, and 27% were residents of long-term care facilities. The predominant organism was Klebsiella pneumoniae (77%), and the most common sources were blood (33%) and respiratory tract (27%); 56% of infections occurred >72 hours after hospital admission. Compared to controls, cases were significantly more likely to have >3 comorbidities (83% vs. 17%, p<0.0001), especially gastrointestinal (77% vs. 39%, p<0.02) or hematologic-oncologic (72% vs. 33%, p<0.02). Cases were more likely to be ventilated (73% vs. 11%, p<0.05) and have had >1 MDRO infection (61% vs. 22%, p<0.02). Cases and controls had similar (P=NS) high rates of invasive medical device use (88% vs. 83%), antibiotic receipt <40 days before infection (77% vs. 72%), and long length of stay (43.1 vs. 31.6 days). The mortality in cases was 23% vs. 12% in controls; however, most deaths were not due directly to infection.
Conclusion: Potential factors associated with KPC-producing Enterobacteriaceae infections in children include ventilated status, recurrent MDRO infection, and chronic comorbidities, in particular gastrointestinal, hematologic-oncologic, or multiple conditions. These findings may help target studies to prevent KPC infections in vulnerable children.
A. H. Bartlett, None
X. Zheng, None
A. Karadkhele, None
R. A. Weinstein, None
L. K. Logan, None