Clinical Characteristics of Carbapenem-resistant Klebsiella pneumoniae Infections in Ill and Colonized Children in Colombia

Background: Multidrug-resistant Gram-negative infections represent a growing problem and a serious global threat. Data in children are scarce. Klebsiella pneumoniae carbapenemases (KPC) are the most common mechanism of resistance this organism has developed. We report the clinical characteristics and outcomes from a cohort of children infected or colonized with carbapenem-resistant K. pneumoniae (CRKp) at a tertiary care center in Medellin, Colombia. Methods: We performed a retrospective chart review of all pediatric cases from whom CRKp isolates were obtained from 2008 to 2013. Clinical characteristics and outcomes were recorded. Results: A total of 34 infected children (median age, 22.8 months) with 43 episodes and 55 colonized patients (median age, 33 months) were identified. All patients had at least 1 risk factor previously related with multidrug-resistant Gram-negative infections (premorbid conditions, previous exposure to antibiotics, prolonged length of stay and use of indwelling devices). Urinary tract infections, abdominal infections and bacteremia were the most common clinical presentations. Overall mortality was 38%, and it was lower when a meropenem-containing regimen was used. Colistin was the most used antibiotic either alone or in combination and was associated with 8.8% of nephrotoxicity. Conclusion: CRKp infections have high mortality in children and usually occur in children with comorbidities, prolonged hospital stay and prior antibiotic exposure. Combined therapy with meropenem-containing regimens seems to be the best option in severely ill children.