Gadisa Eshetu, Egyir Beverly, Fekede Ebissa, Adu Bright, Danso Justice, Oclu Agnes, Owusu-Nyantakyi Christian, Amuasi Grebstad Rabbi, Bortey Alfred, Disasa Guta, Tessema Tesfaye Sisay
Institute of Biotechnology, Addis Ababa University P.O.Box.1176, Addis Ababa, Ethiopia.
Ethiopian Public Health Institute, P.O. Box: 1242, Addis Ababa, Ethiopia.
BMC Infect Dis. 2024 Dec 23;24(1):1458. doi: 10.1186/s12879-024-10366-4.
Early detection and treatment of carbapenem-resistant Klebsiella pneumoniae (CRKP) could reduce the risk of developing life-threatening sepsis in childhood. However, little is known about sepsis caused by CRKP in children under-5 in developing countries. This study aimed to determine the epidemiology, antimicrobial resistance profile, associated risk factors and management of CRKP in children under-5 with sepsis in Ethiopia.
This prospective multicenter study was conducted from June 2021 to December 2023 in three tertiary hospitals in Ethiopia. Samples collection and processing, identification and antimicrobial susceptibility testing were performed according to CLSI guidelines. Sociodemographic data were collected using structured questionnaires. Data were analyzed using STATA-21 and logistic regression to determine associated risk factors. A p-value < 0.05 was considered statistically significant.
Among 2483 children under-5 who were suspected of having sepsis, 530 (21.3%) were infected with K. pneumoniae. Infants and newborns were the most vulnerable age categories, with incidences of 25.3% and 34.2%, respectively. About 92.1% and 47.4% of the isolates were confirmed to produce ESBLs and -carbapenemases, respectively. Thus, isolates were resistant to cephalosporins(91-100%), gentamicin(83.7%), meropenem(49.1%), tigecycline(39%), and amikacin(21%). The prevalence rates of MDR, XDR, and PDR strains were 95.7%, 25.9%, and 11.4%, respectively. Combining amikacin with meropenem or tigecycline was used as a treatment option for XDR and PDR strains. . Regarding risk factors for sepsis caused by K. pneumoniae included prematurity [AOR = 7.1; 95%CI: 2.3-10.3], prolonged hospitalization [AOR = 4.4;95%CI = 1.9-8.2], admission to the ICU [AOR = 6.2;95% CI:2.8-9.2], pneumonia [AOR = 5.1;95%CI:1.6-13.2], meningitis [AOR = 15.3;95%CI:8.1-29.9], UTI [AOR = 2.1; 95%CI = 1.2-4.2], invasive procedures [AOR = 4.8; 95%CI:1.4-15.5], comorbidities [AOR = 4.2;95%CI = 2.2-13.2], parturition [AOR = 5.4;95%CI:2.5-13.3], and membrane rupture [AOR = 12.1; 95%CI = 2.3-26.2].
The prevalence of bacterial sepsis caused by CRKP in children under 5 is high and became a serious public health concern that requires immediate attention and action.Therefore, it is crucial to revise treatment guidelines and improve IPC practices to reduce children's morbidity and mortality from those superbugs and beyond.
早期发现并治疗耐碳青霉烯类肺炎克雷伯菌（CRKP）可降低儿童发生危及生命的败血症的风险。然而，在发展中国家，对于5岁以下儿童由CRKP引起的败血症知之甚少。本研究旨在确定埃塞俄比亚5岁以下败血症儿童中CRKP的流行病学、抗菌药物耐药谱、相关危险因素及治疗情况。
本前瞻性多中心研究于2021年6月至2023年12月在埃塞俄比亚的三家三级医院进行。样本采集与处理、鉴定及抗菌药物敏感性试验均按照美国临床和实验室标准协会（CLSI）指南进行。使用结构化问卷收集社会人口统计学数据。采用STATA-21软件进行数据分析，并通过逻辑回归确定相关危险因素。p值<0.05被认为具有统计学意义。
在2483名疑似患有败血症的5岁以下儿童中，530名（21.3%）感染了肺炎克雷伯菌。婴儿和新生儿是最易感染的年龄组，发病率分别为25.3%和34.2%。分别约有92.1%和47.4%的分离株被证实产超广谱β-内酰胺酶（ESBLs）和碳青霉烯酶。因此，分离株对头孢菌素（91%-100%）、庆大霉素（83.7%）、美罗培南（49.1%）、替加环素（39%）和阿米卡星（21%）耐药。多重耐药（MDR）、广泛耐药（XDR）和泛耐药（PDR）菌株的患病率分别为95.7%、25.9%和11.4%。对于XDR和PDR菌株，采用阿米卡星联合美罗培南或替加环素作为治疗方案。肺炎克雷伯菌引起败血症的危险因素包括早产[AOR=7.1；95%CI：2.3-10.3]、住院时间延长[AOR=4.4；95%CI=1.9-8.2]、入住重症监护病房[AOR=6.2；95%CI：2.8-9.2]、肺炎[AOR=5.1；95%CI：1.6-13.2]、脑膜炎[AOR=15.3；95%CI：8.1-29.9]、尿路感染[AOR=2.1；95%CI=1.2-4.2]、侵入性操作[AOR=4.8；95%CI：1.4-15.5]、合并症[AOR=4.2；95%CI=2.2-13.2]、分娩[AOR=5.4；95%CI：2.5-13.3]和胎膜破裂[AOR=12.1；95%CI=2.3-26.2]。
5岁以下儿童由CRKP引起细菌性败血症的患病率很高，已成为一个严重的公共卫生问题，需要立即关注并采取行动。因此，修订治疗指南并改善感染预防与控制措施以降低儿童因这些超级细菌及其他病菌导致的发病率和死亡率至关重要。
