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Klebsiella pneumoniae Carbapenemase (KPC)-Producing Enterobacteriaceae Infections in Children: A Two-Center Study

Year: 2015

Type: article

Abstract: Background. KPC-producing Enterobacteriaceae are multidrug-resistant organisms (MDROs) that cause major morbidity and mortality worldwide. The epidemiology of KPC infections in U.S. children is understudied and available data are limited primarily to single center studies or outbreaks. We sought to identify factors associated with KPC infections in children hospitalized in two tertiary care medical centers in Chicago, Illinois, 2008–2014. 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% versus 17%, p < 0.0001), especially gastrointestinal (77% versus 39%, p < 0.02) or hematologic-oncologic (72% versus 33%, p < 0.02). Cases were more likely to be ventilated (73% versus 11%, p < 0.05) and have had >1 MDRO infection (61% versus 22%, p < 0.02). Cases and controls had similar (P = NS) high rates of invasive medical device use (88% versus 83%), antibiotic receipt <40 days before infection (77% versus 72%), and long length of stay (43.1 versus 31.6 days). The mortality in cases was 23% versus 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. Disclosures. All authors: No reported disclosures.

Source: Open Forum Infectious Diseases

DOI: 10.1093/ofid/ofv133.1290