Objective: Klebsiella spp. is a common and severe pathogen of bloodstream infections (BSI) due to gram-negative bacilli. Carbapenems are commonly used agents for the treatment of serious infections. However, the incidence of carbapenem-resistant (CR) Klebsiella infections has increased significantly in recent years. The aim of this study was to determine the characteristics, risk factors, and outcomes of BSI caused by Klebsiella spp. in a tertiary care pediatric hospital.

Method: A retrospective review of pediatric patients with BSI caused by Klebsiella spp. between August 2019 and September 2021 was conducted. Patients with CR isolates were compared with carbapenem-susceptible (CS) isolates for risk factors, outcome, and mortality.

Results: Among 345 Klebsiella isolates, 95 (27.5%) were CR. Catheter-related bloodstream infections (CRBSI) accounted for 52.4% of infections. There was an underlying disease in all patients, most commonly malignancy (31.3%). Mechanical ventilation, percutaneous endoscopic gastrostomy (PEG) tube feeding, previous antibiotic use, especially carbapenems, aminoglycosides, glycopeptides, fluoroquinolones, and colistin, (p<0.001, p<0.001, p<0.001, p<0.001, p<0.001, p: 0.033, p<0.001, respectively) were strongly affected the development of BSI due to CR Klebsiella spp. Antibiotic treatment in the previous 14 days increased the risk of developing carbapenem resistance by 14 times. Elevated C-reactive protein (CRP) (p<0.001), thrombocytopenia (p<0.001), CRBSI (p=0.002), use of indwelling devices, previous antibiotic therapy (carbapenems, aminoglycosides, glycopeptides, colistin) (p=0.002), and carbapenem resistance (p=0.001) increased the risk of mortality from Klebsiella-associated BSI. The use of colistin in treatment was higher in the CR group (p<0.001). The 28-day mortality was 15.7%.

Conclusion: CR Klebsiella spp. Infections are important and serious causes of BSI in children. The use of indwelling devices and previous antibiotic therapy are risk factors for mortality and carbapenem resistance. Preventive measures, including targeted antimicrobial therapy, good surveillance networks, and less invasive procedures, are important aspects of infection control management in children.

Keywords: Antibiotic resistance, carbapenem, children, Klebsiella