Department of Neonatology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhuwaihuan Road, Zhengzhou, 450018, Henan, China.
Sci Rep. 2024 Nov 27;14(1):29486. doi: 10.1038/s41598-024-80974-2.
Due to the resistance of carbapenem-resistant Klebsiella pneumoniae (CRKP) to most antibiotics, CRKP treatment is challenging, which results a high mortality rate. CRKP infection poses a significant challenge for infection management and treatment, especially among neonates and premature infants. Therefore, it is important to understand the clinical characteristics of CRKP bloodstream infection (BSI) in premature infants and identify the related risk factors for death. This study aims to explore and analyze the clinical characteristics and risk factors affecting mortality of BSI caused by CRKP in premature infants. A retrospective study was conducted in a Children's Hospital in Henan to analyze clinical data of premature infants with CRKP BSI admitted from January 2015 to December 2022. Univariate and multivariate logistic regression models were utilized to investigate risk factors affecting mortality. Receiver operating characteristic curves were employed to evaluate the predictive value of different indicators on mortality, and differences in area under the curve (AUC) were compared using Stata 17 SE. A total of 96 premature infants with CRKP BSI were enrolled, including 70 patients in the survival group and 26 in the death group. At the onset of infection, 69 (71.9%) patients exhibited persistent tachycardia (heart rate > 180 beats/min), 61 (63.5%) had fever, and 59 (61.4%) experienced apnea episodes. Concurrent meningitis (OR 9.588, 95% CI 1.401-57.613, P = 0.021), concurrent necrotizing enterocolitis (NEC) (OR 7.881, 95% CI 1.672-73.842, P = 0.032), and the maximum vasoactive-inotropic score (VIS) value within 48 h of onset (OR 1.467, 95% CI 1.021-1.782, P = 0.001) were identified as independent risk factors for mortality. The univariate analysis showed that ceftazidime-avibactam (CAZ/AVI) treatment and appropriate early antimicrobial treatment were significantly associated with survival (P < 0.05). The combined predictive AUC for mortality in premature infants with CRKP BSI using the maximum VIS value ≥ 52.5 points within 48 h of onset, concurrent NEC, and purulent meningitis was 0.931 (95% CI 0.856-1.000) with a sensitivity of 92% and specificity of 85.7%. CRKP BSI was a significant mortality risk in premature infants. It is crucial to administer proper antimicrobial therapy in order to increase survival rates of the patients. CAZ/AVI has the potential to improve outcomes in this particular population; however, further research is required to evaluate the effectiveness of specific treatment in premature infants.
由于碳青霉烯类耐药肺炎克雷伯菌（CRKP）对大多数抗生素具有耐药性，因此治疗 CRKP 具有挑战性，这导致其死亡率较高。CRKP 感染对感染管理和治疗构成重大挑战，尤其是在新生儿和早产儿中。因此，了解早产儿 CRKP 血流感染（BSI）的临床特征并确定与死亡相关的风险因素非常重要。本研究旨在探讨和分析 CRKP 引起的早产儿 BSI 的临床特征和影响死亡率的相关因素。对河南省某儿童医院 2015 年 1 月至 2022 年 12 月收治的 96 例 CRKP BSI 早产儿的临床资料进行回顾性研究。采用单因素和多因素 logistic 回归模型分析影响死亡率的相关因素。利用受试者工作特征曲线评估不同指标对死亡率的预测价值，并使用 Stata 17 SE 比较曲线下面积（AUC）的差异。结果显示，共纳入 96 例 CRKP BSI 早产儿，其中存活组 70 例，死亡组 26 例。感染发生时，69 例（71.9%）患者出现持续性心动过速（心率>180 次/分），61 例（63.5%）发热，59 例（61.4%）出现呼吸暂停。合并化脑（OR 9.588，95%CI 1.401-57.613，P=0.021）、合并坏死性小肠结肠炎（NEC）（OR 7.881，95%CI 1.672-73.842，P=0.032）和发病 48 h 内最大血管活性药物-正性肌力药物评分（VIS）值（OR 1.467，95%CI 1.021-1.782，P=0.001）是死亡的独立危险因素。单因素分析显示，头孢他啶-阿维巴坦（CAZ/AVI）治疗和早期适当的抗菌治疗与生存显著相关（P<0.05）。在发病 48 h 内最大 VIS 值≥52.5 分、合并 NEC 和化脓性脑膜炎的 CRKP BSI 早产儿死亡的联合预测 AUC 为 0.931（95%CI 0.856-1.000），敏感性为 92%，特异性为 85.7%。CRKP BSI 是早产儿死亡的重要危险因素。给予适当的抗菌治疗以提高患者的生存率至关重要。CAZ/AVI 有可能改善该人群的结局；然而，需要进一步研究来评估特定治疗方案在早产儿中的有效性。
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