Medical Science Laboratory, Children's Hospital, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530003, People's Republic of China.
BMC Infect Dis. 2024 Nov 16;24(1):1311. doi: 10.1186/s12879-024-10201-w.
With the continuous advancement of modern medical technology, the survival rate of premature infants has significantly increased. Klebsiella pneumoniae (K. pneumoniae) is one of the most common pathogens causing neonatal infections, particularly posing a serious risk to premature infants. This study aimed to analyze the clinical characteristics, antibiotic susceptibility profiles, and treatment outcomes of K. pneumoniae infections in these infants.
We retrospectively compared cases of K. pneumoniae infection in premature and term infants admitted in a tertiary hospital from January 2017 to December 2022 in China. Clinical and microbiological characteristics were evaluated. Data analysis was performed using the Statistical Package for the Social Sciences (SPSS), with statistical significance defined as P < 0.05.
We enrolled 166 premature infants and 68 term infants. In premature infants, fetal distress, patent ductus arteriosus, patent foramen ovale, enteritis, anemia, hypoproteinemia, bloodstream infections, abdominal infection, mechanical ventilation, nasogastric feeding, drainage tube, parenteral nutrition, and prior exposure to carbapenem antibiotics were identified as significant risk factors for K. pneumoniae infections in univariate analysis. Furthermore, septic shock, bloodstream infections, abdominal infections, indwelling catheters, drainage tubes, parenteral nutrition, and previous exposure to glycopeptide antibiotics were significantly correlated with mortality. Independent risk factors for K. pneumoniae infections in premature infants included fetal distress (OR: 3.702, [95% CI: 1.056-12.986], P = 0.041), enteritis (OR: 4.434, [95% CI: 1.066-18.451], P = 0.041), anemia (OR: 4.028, [95% CI: 1.550-10.466], P = 0.004), bloodstream infections (OR: 1.221, [95% CI: 0.061-1.802], P = 0.022), mechanical ventilation (OR: 4.974, [95% CI: 1.685-14.685], P = 0.004) and prior exposure to carbapenem antibiotic (OR: 14.738, [95% CI: 2.393-90.767], P = 0.004). Additionally, abdominal infections (OR: 8.598, [95% CI: 2.000-36.957], P = 0.004) and indwelling catheters (OR: 7.698, [95% CI: 0.998-59.370], P = 0.050) were positive predictors of mortality.
K. pneumoniae isolates exhibit a notable prevalence of infection, poor treatment outcomes, and elevated resistance in preterm neonates. These findings enhance our understanding of K. pneumoniae infections and their association with clinical outcomes among premature infants.
随着现代医疗技术的不断进步，早产儿的存活率显著提高。肺炎克雷伯菌（K. pneumoniae）是导致新生儿感染的最常见病原体之一，尤其对早产儿构成严重威胁。本研究旨在分析中国某三级医院住院的早产儿和足月儿中肺炎克雷伯菌感染的临床特征、抗生素药敏谱和治疗结局。
我们回顾性比较了 2017 年 1 月至 2022 年 12 月在中国某三级医院住院的肺炎克雷伯菌感染的早产儿和足月儿病例。评估了临床和微生物学特征。使用社会科学统计软件包（SPSS）进行数据分析，P<0.05 为差异有统计学意义。
我们纳入了 166 例早产儿和 68 例足月儿。在早产儿中，胎儿窘迫、动脉导管未闭、卵圆孔未闭、肠炎、贫血、低蛋白血症、血流感染、腹部感染、机械通气、鼻胃管喂养、引流管、肠外营养和先前暴露于碳青霉烯类抗生素是肺炎克雷伯菌感染的显著危险因素。此外，败血症性休克、血流感染、腹部感染、留置导管、引流管、肠外营养和先前暴露于糖肽类抗生素与死亡率显著相关。肺炎克雷伯菌感染的独立危险因素包括胎儿窘迫（OR：3.702，95%CI：1.056-12.986，P=0.041）、肠炎（OR：4.434，95%CI：1.066-18.451，P=0.041）、贫血（OR：4.028，95%CI：1.550-10.466，P=0.004）、血流感染（OR：1.221，95%CI：0.061-1.802，P=0.022）、机械通气（OR：4.974，95%CI：1.685-14.685，P=0.004）和先前暴露于碳青霉烯类抗生素（OR：14.738，95%CI：2.393-90.767，P=0.004）。此外，腹部感染（OR：8.598，95%CI：2.000-36.957，P=0.004）和留置导管（OR：7.698，95%CI：0.998-59.370，P=0.050）是死亡的阳性预测因子。
肺炎克雷伯菌在早产儿中感染发生率高，治疗结局差，耐药性强。这些发现提高了我们对肺炎克雷伯菌感染及其与早产儿临床结局关系的认识。
