Abstract
Background
Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging threat in pediatric healthcare settings because of limited treatment options and high morbidity and mortality. However, data regarding pediatric CRKP bloodstream infection (BSI) remain limited. This study aimed to evaluate the clinical characteristics and outcomes of CRKP BSI in children.Methods
A retrospective cohort study was conducted among children hospitalized with Klebsiella pneumoniae BSI between 2020 and 2025. Demographic characteristics, healthcare exposures, laboratory findings, antimicrobial therapy, and clinical outcomes were analyzed.Results
A total of 86 children were included; the median age was 12 months, and 50% were male. Overall, 91.9% had at least one underlying comorbidity, 89.5% had a history of previous hospitalization, 83.3% had prior antibiotic usage, and 25.9% had undergone surgical intervention. During the index hospitalization, 57.0% required intensive care unit admission and 77.6% had at least one invasive device. Fifteen children (17.4%) had CRKP BSI. Prior carbapenem exposure and longer antibiotic use were more frequent in the CRKP group, although the differences were not statistically significant. White blood cell, neutrophil, lymphocyte, and platelet counts were significantly lower in patients with CRKP BSI. Three-month mortality was 40.0% in the CRKP group and 15.9% in the CSKP group, with no statistically significant difference (p = 0.069). Length of hospital stay was also similar between the groups.Conclusion
CRKP accounted for 17.4% of K. pneumoniae BSIs in this pediatric cohort. No independent factor associated with carbapenem resistance was identified. The small number of CRKP cases limited the statistical power of the study. Larger multicenter studies are needed to better define factors associated with CRKP and its clinical outcomes in children.