Introduction
Methods
Study designs and patients
Data collection and definitions
Clinical outcomes
Statistical analysis
Results
Study population
Clinical characteristic of K. pneumoniae bloodstream infection in children
Characteristics | Number/median | Percent/IQR |
---|---|---|
Demographic characteristics | ||
Male (n, %) | 42 | 61.69 |
Age (years) (median, IQR) | 4.33 | 0.76–10.67 |
Underlying conditions | ||
Hematologic malignancy (n, %) | 44 | 65.67 |
Immunosuppression (n, %) | 41 | 61.19 |
Congenital heart disease (n, %) | 14 | 20.90 |
Sources of infection | ||
Respiratory tract (n, %) | 37 | 55.22 |
Gastrointestinal tract (n, %) | 14 | 20.90 |
Unknown source (n, %) | 10 | 14.93 |
Invasive operation (n, %) | 5 | 7.46 |
Urinary tract (n, %) | 1 | 1.49 |
Drug resistant bacteria phenotypes | ||
Sulbactam resistant (n, %) | 40 | 59.70 |
Extended spectrum beta-lactamase (n, %) | 32 | 47.76 |
Cephalosporin resistant (n, %) | 15 | 22.39 |
Tazobactam resistant (n, %) | 14 | 20.90 |
Carbapenem resistant (n, %) | 7 | 10.45 |
Multidrug resistant (n, %) | 6 | 8.96 |
Aminoglycoside resistant (n, %) | 4 | 5.97 |
Empiric antimicrobial treatment | ||
Carbapenem (n, %) | 38 | 56.72 |
Fourth-generation cephalosporin (n, %) | 9 | 13.43 |
Third-generation cephalosporin (n, %) | 8 | 11.94 |
Tazobactam (n, %) | 7 | 10.45 |
Second-generation cephalosporin (n, %) | 3 | 4.48 |
Sulbactam (n, %) | 2 | 2.99 |
Length of stay before the onset of bloodstream infection (days) (median, IQR) | 13.68 | 6.59–17.53 |
Length of hospitalization stay (days) (median, IQR) | 28.96 | 20.04–42.75 |
The peak of temperature (centigrade) (median, IQR) | 39.8 | 39.3–40.1 |
Antimicrobials administrated prior to blood culture (n, %) | 28 | 41.79 |
With secondary hypoalbuminemia during hospitalization (n, %) | 22 | 32.84 |
PRISM III score (median, IQR) | 8 | 3–9 |
TTP (h) (median, IQR) | 14.12 | 12.72–16.22 |
TTAT (h) (median, IQR) | 4.52 | 0.97–14.18 |
Need for invasive mechanical ventilation (n, %) | 11 | 16.42 |
Septic shock (n, %) | 12 | 17.91 |
In-hospital mortality (n, %) | 9 | 13.43 |
TTAT of K. pneumoniae bloodstream infection in children
Clinical characteristics differences between the early and delayed therapy groups
Characteristics | delayed therapy (n = 23) | early therapy (n = 44) | P |
---|---|---|---|
Demographic characteristics | |||
Male (n, %) | 13 (56.52%) | 29 (65.91%) | 0.451 |
Age (median, IQR) | 0.85 (0.52–9.75) | 5.75 (2.50–11.05) | 0.070 |
Underlying conditions | |||
Hematologic malignancy (n, %) | 7 (30.43%) | 37 (84.09%) | 0.000* |
Immunosuppression (n, %) | 9 (39.13%) | 32 (72.73%) | 0.007* |
Congenital heart disease (n, %) | 8 (34.78%) | 6 (13.64%) | 0.088 |
Sources of infection | |||
Respiratory tract (n, %) | 11 (47.83%) | 26 (59.09%) | 0.379 |
Gastrointestinal tract (n, %) | 5 (21.74%) | 9 (20.45%) | 1.000 |
Unknown source (n, %) | 5 (21.74%) | 5 (11.36%) | 0.441 |
Invasive operation (n, %) | 2 (8.70%) | 3 (6.82%) | 1.000 |
Urinary tract (n, %) | 0 (0.00%) | 1 (2.27%) | 1.000 |
Drug resistant bacteria phenotypes | |||
Sulbactam resistant (n, %) | 16 (69.57%) | 24 (54.55%) | 0.234 |
Extended spectrum beta-lactamase (n, %) | 14 (60.87%) | 18 (40.91%) | 0.120 |
Cephalosporin resistant (n, %) | 9 (39.13%) | 6 (13.64%) | 0.017* |
Tazobactam resistant (n, %) | 6 (26.09%) | 8 (18.18%) | 0.660 |
Carbapenem resistant (n, %) | 3 (13.04%) | 4 (9.09%) | 0.935 |
Multidrug resistant (n, %) | 2 (8.70%) | 4 (9.09%) | 1.000 |
Aminoglycoside resistant (n, %) | 2 (8.70%) | 2 (4.55%) | 0.890 |
Empiric antimicrobial treatment (n, %) | |||
Carbapenem (n, %) | 8 (34.78%) | 30 (68.18%) | 0.009* |
Fourth-generation cephalosporin (n, %) | 3 (13.04%) | 6 (13.64%) | 1.000 |
Third-generation cephalosporin (n, %) | 6 (26.09%) | 2 (4.55%) | 0.029* |
Tazobactam (n, %) | 4 (17.39%) | 3 (6.82%) | 0.356 |
Second-generation cephalosporin (n, %) | 0 (0.00%) | 3 (6.82%) | 0.510 |
Sulbactam (n, %) | 2 (8.70%) | 0 (0.00%) | 0.114 |
Length of stay before the onset of bloodstream infection (median, IQR) | 11.75 (7.14–23.13) | 14.42 (10.50–17.19) | 0.561 |
Length of hospitalization stay (median, IQR) | 24.00 (12.92–38.88) | 30.90 (22.98–46.93) | 0.080 |
The peak of temperature (median, IQR) | 39.6 (39.1–40.0) | 39.9 (39.3–40.4) | 0.135 |
Antimicrobials administrated prior to blood culture (n, %) | 14 (60.87%) | 14 (31.82%) | 0.022* |
With secondary hypoalbuminemia during hospitalization (n, %) | 13 (56.52%) | 9 (20.45%) | 0.002* |
PRISM III scores ≥ 10 (n, %) | 3 (13.04%) | 3 (6.82%) | 0.692 |
TTP ≤ 13 h (n, %) | 7 (30.43%) | 12 (27.27%) | 0.785 |
Need for invasive mechanical ventilation (n, %) | 8 (34.78%) | 3 (6.82%) | 0.010* |
Septic shock (n, %) | 9 (39.13%) | 3 (6.82%) | 0.003* |
In-hospital mortality (n, %) | 7 (30.43%) | 2 (4.55%) | 0.010* |
Comparisons of clinical characteristics between the survival and non-survival groups
Characteristics | Non-survival (n = 9) | Survival (n = 58) | P |
---|---|---|---|
Demographic characteristics | |||
Male (n, %) | 4 (44.44%) | 38 (65.52%) | 0.398 |
Age (median, IQR) | 9.75 (1.72–12.13) | 4.29 (0.73–9.69) | 0.316 |
Underlying conditions | |||
Hematologic malignancy (n, %) | 5 (55.56%) | 39 (67.24%) | 0.757 |
Immunosuppression (n, %) | 5 (55.56%) | 36 (62.07%) | 0.996 |
Congenital heart disease (n, %) | 1 (11.11%) | 13 (22.41%) | 0.737 |
Sources of infection | |||
Respiratory tract (n, %) | 5 (55.56%) | 32 (55.17%) | 1.000 |
Gastrointestinal tract (n, %) | 2 (22.22%) | 12 (20.69%) | 1.000 |
Unknown source (n, %) | 2 (22.22%) | 8 (13.79%) | 0.875 |
Invasive operation (n, %) | 0 (0.00%) | 5 (8.62%) | 1.000 |
Urinary tract (n, %) | 0 (0.00%) | 1 (1.72%) | 1.000 |
Drug resistant bacteria phenotypes | |||
Sulbactam resistant (n, %) | 8 (88.89%) | 32 (55.17%) | 0.120 |
Extended spectrum beta-lactamase (n, %) | 8 (88.89%) | 24 (41.38%) | 0.022* |
Cephalosporin resistant (n, %) | 5 (55.56%) | 10 (17.24%) | 0.033* |
Tazobactam resistant (n, %) | 3 (33.33%) | 11 (18.97%) | 0.585 |
Carbapenem resistant (n, %) | 2 (22.22%) | 5 (8.62%) | 0.235 |
Multidrug resistant (n, %) | 2 (22.22%) | 4 (6.90%) | 0.181 |
Aminoglycoside resistant (n, %) | 2 (22.22%) | 2 (3.45%) | 0.084 |
Empiric antimicrobial treatment | |||
Carbapenem (n, %) | 6 (66.67%) | 32 (55.17%) | 0.775 |
Fourth-generation cephalosporin (n, %) | 0 (0.00%) | 9 (15.52%) | 0.456 |
Third-generation cephalosporin (n, %) | 1 (11.11%) | 7 (12.07%) | 1.000 |
Tazobactam (n, %) | 1 (11.11%) | 6 (10.34%) | 1.000 |
Second-generation cephalosporin (n, %) | 0 (0.00%) | 3 (5.17%) | 1.000 |
Sulbactam (n, %) | 1 (11.11%) | 1 (1.72%) | 0.252 |
Length of stay before the onset of bloodstream infection (median, IQR) | 16.76 (8.88–33.00) | 13.23 (8.47–17.28) | 0.211 |
Length of hospitalization stay (median, IQR) | 24.00 (10.63–52.65) | 29.46 (22.59–43.74) | 0.594 |
The peak of temperature (median, IQR) | 39.6 (39.0–40.0) | 39.8 (39.3–40.2) | 0.407 |
Antimicrobials administrated prior to blood culture (n, %) | 8 (88.89%) | 20 (34.48%) | 0.007* |
With secondary hypoalbuminemia during hospitalization (n, %) | 6 (66.67%) | 16 (27.59%) | 0.052 |
PRISM III scores ≥ 10 (n, %) | 3 (33.33%) | 3 (5.17%) | 0.028* |
TTP ≤ 13 h (n, %) | 6 (66.67%) | 13 (22.41%) | 0.019* |
TTAT ≥ 10.7 h (n, %) | 7 (77.78%) | 16 (27.59%) | 0.010* |
Need for invasive mechanical ventilation (n, %) | 5 (55.56%) | 6 (10.34%) | 0.003* |
Septic shock (n, %) | 9 (100.00%) | 3 (5.17%) | 0.000* |
Risk factors of in-hospital mortality
Variables | Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
OR | 95%CI | P | OR | 95%CI | P | |
PRISM III scores ≥ 10 | 9.17 | 1.50–55.93 | 0.016* | 40.06 | 2.32–691.35 | 0.011* |
TTP ≤ 13 h | 6.92 | 1.52–31.56 | 0.012* | 22.60 | 1.78–287.27 | 0.016* |
TTAT ≥ 10.7 h | 9.19 | 1.72–48.98 | 0.009* | 22.19 | 1.25–393.94 | 0.035* |
Need for invasive mechanical ventilation | 10.83 | 2.27–51.71 | 0.003* | 12.21 | 1.06–140.67 | 0.045* |
Extended spectrum beta-lactamase bacteria | 11.33 | 1.33–96.67 | 0.026* | |||
Cephalosporin resistant bacteria | 6.00 | 1.37–26.38 | 0.018* | |||
With secondary hypoalbuminemia during hospitalization | 3.73 | 1.03–13.59 | 0.046* |
Risk factors of septic shock
Variables | Univariate analysis | Multivariate analysis | ||||
---|---|---|---|---|---|---|
OR | 95%CI | P | OR | 95%CI | P | |
TTAT ≥ 10.7 h | 8.79 | 2.08–37.11 | 0.003* | 9.87 | 1.46–66.59 | 0.019* |
PRISM III scores ≥ 10 | 5.78 | 1.00–33.24 | 0.049* | 9.69 | 1.15–81.39 | 0.036* |
TTP ≤ 13 h | 5.02 | 1.35–18.67 | 0.016* | 8.28 | 1.37–50.10 | 0.021* |
Need for invasive mechanical ventilation | 10.00 | 2.33–42.97 | 0.002* | 6.52 | 1.08–39.51 | 0.042* |
With secondary hypoalbuminemia during hospitalization | 5.25 | 1.17–23.55 | 0.030* | |||
Extended spectrum beta-lactamase bacteria | 4.17 | 1.02–17.13 | 0.047* | |||
Cephalosporin resistant bacteria | 3.21 | 0.84–12.23 | 0.087 |