Klebsiella pneumoniae bloodstream infections at a South African children’s hospital 2006–2011, a cross-sectional study
Identifieur interne : 000615 ( Pmc/Curation ); précédent : 000614; suivant : 000616Klebsiella pneumoniae bloodstream infections at a South African children’s hospital 2006–2011, a cross-sectional study
Auteurs : Heloise Buys [Afrique du Sud] ; Rudzani Muloiwa [Afrique du Sud] ; Colleen Bamford [Afrique du Sud] ; Brian Eley [Afrique du Sud]Source :
- BMC Infectious Diseases [ 1471-2334 ] ; 2016.
Abstract
We conducted a retrospective cross-sectional study of KPBSI from 1 January 2006 to 31 December 2011 using conventional descriptive and inferential statistical methods.
Of 410 hospitalised children with laboratory confirmed KPBSI, 339 (83 %) were caused by extended-spectrum β-lactamase (ESBL) producing isolates. The median age (IQR) was 5.0 (2–16) months, 212 (51.7 %) were male, 82 (20 %) were HIV-infected, and 241 (58.8 %) were moderately or severely underweight. The infection was hospital-acquired or healthcare-associated in 389 (95 %) children and community-acquired in 21 (5 %) children. Significant risk factors for ESBL-KPBSI included cephalosporin exposure in the 12 months prior to the KPBSI, adjusted risk ratio (aRR) 1.18 (95 % CI: 1.06–1.31); HIV infection, aRR 1.14 (1.04–1.25), and intravenous infusions for more than 3 days before the KPBSI, aRR 1.15 (95 % CI: 1.04–1.28).
A total of 109 (26.6 %) children died within 30 days of the KPBSI, their median age was four (IQR 1–11) months. The median (IQR) time between KPBSI and death was three (1–9) days. HIV-infection, aRR 2.44(95 % CI: 1.59–3.74); skin erosions at the time of KPBSI, aRR 2.15 (95 % CI: 1.54–3.00); being in PICU at the time of the KPBSI, aRR 1.64 (95 % CI: 1.03–2.61) or needing PICU admission after developing KPBSI, aRR 1.72 (95 % CI: 1.10–2.70) were significant risk factors for death.
ESBL-producing KP is an important cause of laboratory confirmed bloodstream infection in hospitalised children and is associated with high mortality.
Url:
DOI: 10.1186/s12879-016-1919-y
PubMed: 27751185
PubMed Central: 5067886
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Heloise Buys<affiliation><nlm:aff id="Aff1">Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Cape Town, Rondebosch 7700 South Africa</nlm:aff>
<wicri:noCountry code="subfield">Rondebosch 7700 South Africa</wicri:noCountry>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff2">University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>University of Cape Town, Cape Town</wicri:regionArea>
</affiliation>
<affiliation><nlm:aff id="Aff3">Ambulatory and Emergency Paediatrics, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Cape Town, Rondebosch 7700 South Africa</nlm:aff>
<wicri:noCountry code="subfield">Rondebosch 7700 South Africa</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="Aff3">Ambulatory and Emergency Paediatrics, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Cape Town, Rondebosch 7700 South Africa</nlm:aff>
<wicri:noCountry code="subfield">Rondebosch 7700 South Africa</wicri:noCountry>
</affiliation>
<affiliation><nlm:aff id="Aff1">Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Cape Town, Rondebosch 7700 South Africa</nlm:aff>
<wicri:noCountry code="subfield">Rondebosch 7700 South Africa</wicri:noCountry>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff2">University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>University of Cape Town, Cape Town</wicri:regionArea>
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<affiliation><nlm:aff id="Aff1">Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Cape Town, Rondebosch 7700 South Africa</nlm:aff>
<wicri:noCountry code="subfield">Rondebosch 7700 South Africa</wicri:noCountry>
</affiliation>
<affiliation wicri:level="1"><nlm:aff id="Aff2">University of Cape Town, Cape Town, South Africa</nlm:aff>
<country xml:lang="fr">Afrique du Sud</country>
<wicri:regionArea>University of Cape Town, Cape Town</wicri:regionArea>
</affiliation>
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<sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main"><italic>Klebsiella pneumoniae</italic>
bloodstream infections at a South African children’s hospital 2006–2011, a cross-sectional study</title>
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<wicri:noCountry code="subfield">Rondebosch 7700 South Africa</wicri:noCountry>
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<series><title level="j">BMC Infectious Diseases</title>
<idno type="eISSN">1471-2334</idno>
<imprint><date when="2016">2016</date>
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<front><div type="abstract" xml:lang="en"><sec><title>Background</title>
<p><italic>Klebsiella pneumoniae</italic>
(KP) is a significant paediatric bloodstream pathogen in children. There is little data from Africa. In this study we describe the epidemiology of multi-drug resistant <italic>Klebsiella pneumoniae</italic>
bloodstream infection (KPBSI) at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa.</p>
</sec>
<sec><title>Methods</title>
<p>We conducted a retrospective cross-sectional study of KPBSI from 1 January 2006 to 31 December 2011 using conventional descriptive and inferential statistical methods.</p>
</sec>
<sec><title>Results</title>
<p>Of 410 hospitalised children with laboratory confirmed KPBSI, 339 (83 %) were caused by extended-spectrum β-lactamase (ESBL) producing isolates. The median age (IQR) was 5.0 (2–16) months, 212 (51.7 %) were male, 82 (20 %) were HIV-infected, and 241 (58.8 %) were moderately or severely underweight. The infection was hospital-acquired or healthcare-associated in 389 (95 %) children and community-acquired in 21 (5 %) children. Significant risk factors for ESBL-KPBSI included cephalosporin exposure in the 12 months prior to the KPBSI, adjusted risk ratio (aRR) 1.18 (95 % CI: 1.06–1.31); HIV infection, aRR 1.14 (1.04–1.25), and intravenous infusions for more than 3 days before the KPBSI, aRR 1.15 (95 % CI: 1.04–1.28).</p>
<p>A total of 109 (26.6 %) children died within 30 days of the KPBSI, their median age was four (IQR 1–11) months. The median (IQR) time between KPBSI and death was three (1–9) days. HIV-infection, aRR 2.44(95 % CI: 1.59–3.74); skin erosions at the time of KPBSI, aRR 2.15 (95 % CI: 1.54–3.00); being in PICU at the time of the KPBSI, aRR 1.64 (95 % CI: 1.03–2.61) or needing PICU admission after developing KPBSI, aRR 1.72 (95 % CI: 1.10–2.70) were significant risk factors for death.</p>
</sec>
<sec><title>Conclusion</title>
<p>ESBL-producing KP is an important cause of laboratory confirmed bloodstream infection in hospitalised children and is associated with high mortality.</p>
</sec>
</div>
</front>
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<author><name sortKey="Williams, T" uniqKey="Williams T">T Williams</name>
</author>
<author><name sortKey="Bauni, E" uniqKey="Bauni E">E Bauni</name>
</author>
<author><name sortKey="Mwarumba, S" uniqKey="Mwarumba S">S Mwarumba</name>
</author>
<author><name sortKey="Ngetsa, C" uniqKey="Ngetsa C">C Ngetsa</name>
</author>
<author><name sortKey="Slack, Mp" uniqKey="Slack M">MP Slack</name>
</author>
<author><name sortKey="Njenga, S" uniqKey="Njenga S">S Njenga</name>
</author>
<author><name sortKey="Hart, Ca" uniqKey="Hart C">CA Hart</name>
</author>
</analytic>
</biblStruct>
<biblStruct></biblStruct>
</listBibl>
</div1>
</back>
</TEI>
<pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Infect Dis</journal-id>
<journal-id journal-id-type="iso-abbrev">BMC Infect. Dis</journal-id>
<journal-title-group><journal-title>BMC Infectious Diseases</journal-title>
</journal-title-group>
<issn pub-type="epub">1471-2334</issn>
<publisher><publisher-name>BioMed Central</publisher-name>
<publisher-loc>London</publisher-loc>
</publisher>
</journal-meta>
<article-meta><article-id pub-id-type="pmid">27751185</article-id>
<article-id pub-id-type="pmc">5067886</article-id>
<article-id pub-id-type="publisher-id">1919</article-id>
<article-id pub-id-type="doi">10.1186/s12879-016-1919-y</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title><italic>Klebsiella pneumoniae</italic>
bloodstream infections at a South African children’s hospital 2006–2011, a cross-sectional study</article-title>
</title-group>
<contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Buys</surname>
<given-names>Heloise</given-names>
</name>
<address><phone>+27 21 658 5169</phone>
<email>heloise.buys@uct.ac.za</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
<xref ref-type="aff" rid="Aff2">2</xref>
<xref ref-type="aff" rid="Aff3">3</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Muloiwa</surname>
<given-names>Rudzani</given-names>
</name>
<address><email>rudzani.muloiwa@uct.ac.za</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
<xref ref-type="aff" rid="Aff2">2</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Bamford</surname>
<given-names>Colleen</given-names>
</name>
<address><email>colleen.bamford@nhls.ac.za</email>
</address>
<xref ref-type="aff" rid="Aff2">2</xref>
<xref ref-type="aff" rid="Aff4">4</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Eley</surname>
<given-names>Brian</given-names>
</name>
<address><email>brian.eley@uct.ac.za</email>
</address>
<xref ref-type="aff" rid="Aff1">1</xref>
<xref ref-type="aff" rid="Aff2">2</xref>
</contrib>
<aff id="Aff1"><label>1</label>
Department of Paediatrics and Child Health, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Cape Town, Rondebosch 7700 South Africa</aff>
<aff id="Aff2"><label>2</label>
University of Cape Town, Cape Town, South Africa</aff>
<aff id="Aff3"><label>3</label>
Ambulatory and Emergency Paediatrics, Red Cross War Memorial Children’s Hospital, Klipfontein Road, Cape Town, Rondebosch 7700 South Africa</aff>
<aff id="Aff4"><label>4</label>
National Health Laboratory Service (Groote Schuur Hospital), Cape Town, South Africa</aff>
</contrib-group>
<pub-date pub-type="epub"><day>17</day>
<month>10</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="pmc-release"><day>17</day>
<month>10</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="collection"><year>2016</year>
</pub-date>
<volume>16</volume>
<elocation-id>570</elocation-id>
<history><date date-type="received"><day>28</day>
<month>2</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>12</day>
<month>10</month>
<year>2016</year>
</date>
</history>
<permissions><copyright-statement>© The Author(s). 2016</copyright-statement>
<license license-type="OpenAccess"><license-p><bold>Open Access</bold>
This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>
), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>
) applies to the data made available in this article, unless otherwise stated.</license-p>
</license>
</permissions>
<abstract id="Abs1"><sec><title>Background</title>
<p><italic>Klebsiella pneumoniae</italic>
(KP) is a significant paediatric bloodstream pathogen in children. There is little data from Africa. In this study we describe the epidemiology of multi-drug resistant <italic>Klebsiella pneumoniae</italic>
bloodstream infection (KPBSI) at Red Cross War Memorial Children’s Hospital, Cape Town, South Africa.</p>
</sec>
<sec><title>Methods</title>
<p>We conducted a retrospective cross-sectional study of KPBSI from 1 January 2006 to 31 December 2011 using conventional descriptive and inferential statistical methods.</p>
</sec>
<sec><title>Results</title>
<p>Of 410 hospitalised children with laboratory confirmed KPBSI, 339 (83 %) were caused by extended-spectrum β-lactamase (ESBL) producing isolates. The median age (IQR) was 5.0 (2–16) months, 212 (51.7 %) were male, 82 (20 %) were HIV-infected, and 241 (58.8 %) were moderately or severely underweight. The infection was hospital-acquired or healthcare-associated in 389 (95 %) children and community-acquired in 21 (5 %) children. Significant risk factors for ESBL-KPBSI included cephalosporin exposure in the 12 months prior to the KPBSI, adjusted risk ratio (aRR) 1.18 (95 % CI: 1.06–1.31); HIV infection, aRR 1.14 (1.04–1.25), and intravenous infusions for more than 3 days before the KPBSI, aRR 1.15 (95 % CI: 1.04–1.28).</p>
<p>A total of 109 (26.6 %) children died within 30 days of the KPBSI, their median age was four (IQR 1–11) months. The median (IQR) time between KPBSI and death was three (1–9) days. HIV-infection, aRR 2.44(95 % CI: 1.59–3.74); skin erosions at the time of KPBSI, aRR 2.15 (95 % CI: 1.54–3.00); being in PICU at the time of the KPBSI, aRR 1.64 (95 % CI: 1.03–2.61) or needing PICU admission after developing KPBSI, aRR 1.72 (95 % CI: 1.10–2.70) were significant risk factors for death.</p>
</sec>
<sec><title>Conclusion</title>
<p>ESBL-producing KP is an important cause of laboratory confirmed bloodstream infection in hospitalised children and is associated with high mortality.</p>
</sec>
</abstract>
<kwd-group xml:lang="en"><title>Keywords</title>
<kwd><italic>Klebsiella pneumoniae</italic>
bloodstream infection</kwd>
<kwd>Children</kwd>
<kwd>Africa</kwd>
</kwd-group>
<funding-group><award-group><funding-source><institution-wrap><institution-id institution-id-type="FundRef">http://dx.doi.org/10.13039/501100004513</institution-id>
<institution>Harry Crossley Foundation</institution>
</institution-wrap>
</funding-source>
</award-group>
</funding-group>
<custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name>
<meta-value>© The Author(s) 2016</meta-value>
</custom-meta>
</custom-meta-group>
</article-meta>
</front>
</pmc>
</record>
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