Microbiological characteristics, risk factors and mortality in children with bloodstream infection of carbapenem resistance Enterobacteriaceae: a 10-year longitudinal study

Background: Carbapenem-resistant Enterobacteriaceae (CRE) is rapidly becoming a major threat to hospitalized children worldwide. The purpose of this study was to summarize etiological characteristics and identify risk factors relevant to CRE bloodstream infection and short-term mortality among pediatric patients in China. Methods: In this study, we included 370 inpatients ≤ 17 years old with BSI caused by CRE in China from January 2013 to December 2022. By collecting data on demographics, etiological features, and clinical outcomes, we conducted an in-depth analysis. Result: Among the 370 BSI patients, there were 35 patients (9.46 %) caused by CRE and 335 patients (90.54 %) by carbapenem-susceptible Enterobacteriaceae (CSE). Among these CRE strains, Klebsiella pneumoniae was the most important pathogen of BSI in pediatric patients, followed by Escherichia coli and Enterobacter cloacae . The most frequent carbapenemase was NDM (23/35, 65.71%), followed by KPC (8/35, 22.86%). The overall 28-day mortality rate of children with an Enterobacteriaceae BSI episode was 1.89 % (7/370 ), of which CRE BSI patients (3/ 35, 8.57 %) were significantly higher than CSE patients (4 / 335, 1.19 %， P < 0.001). Congenital malformation (OR:8.162, 95% CI: 3.859 - 16.680, P<0.001), CRP >10 mg/mL (OR:18.870, 95%CI 6.154 - 59.400, P: <0.0001) and catheter-related (OR: 6.645, 95% CI: 3.159 - 13.28, P: <0.0001) were found to be associated with the development of CRE BSI in pediatric patients. A multivariate analysis showed that the colonization and infection of CRE (OR 7.758, 95% CI 1.869-29.62, P = 0.021) were independent risk factors for 28-day mortality of Enterobacteriaceae BSI. When the MIC of carbapenems is ≥ 8 μg/mL, the admission rate and mortality rate in the ICU were higher(P<0.05). Conclusions: Congenital malformation, previous cephalosporin/carbapenems administration, and catheter-related conditions are closely related to the development of CRE BSI in pediatric patients. The mortality rate of CRE BSI is higher. NDM was the predominant carbapenemase-producing mechanism among CRE strains causing BSI in children.