Clinical implications and risk factors of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae infection in children: A case-control retrospective study in a medical center in southern Taiwan

Background and Purpose: Infections caused by extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacilli constitute a growing problem worldwide. However, studies focusing on children are limited. Methods: We have observed an increase in cases of ESBL-producing Klebsiella pneumoniae (ESBL-KP) infections in the past 6 years in our hospital in southern Taiwan. Using a case-control study design, we compared the clinical characteristics between 54 patients infected by ESBL-KP and 54 frequency-matched controls infected by non-ESBL-producing isolates. Results: Risk factors associated with the infection of ESBL-KP were mainly longer pre-infection hospital stay and recent antibiotic exposure (within 30 days before the episode). Other potential risk factors included recent surgery, the application of mechanical ventilation, nasogastric tubes and central venous catheter insertion. ESBL-KP-related infection cases had a longer hospital stay than controls, and also had a higher mortality rate, although not significantly so. Conclusions: Recent antibiotic exposure was by far the most important predisposing factor associated with infection of ESBL-KP. Unnecessary antibiotic use should be avoided both in the hospital and community, especially ceftazidime, vancomycin/teicoplanin, aminoglycosides and ampicillin. In our study, carbapenem antibiotics remained the most active drugs against ESBL-KP in pediatric patients, while flomoxef and ciprofloxacin were suitable alternative choices.