Monitoring of Klebsiella pneumoniae infection and drug resistance in 17 pediatric intensive care units in China from 2016 to 2022

Abstract

Abstract Objective To investigate the characteristics and drug resistance patterns of Klebsiella pneumoniae (KPN) infection among children admitted to pediatric intensive care unit (PICU). Methods KPN strains obtained from 17 domestic PICUs between January 1, 2016, and December 31, 2022, were collected for analysis. The overall condition and drug resistance patterns were assessed utilizing the WHO-NET software. Results A total of 26613 strains were identified, and 2591 (9.7%) KPN strains were isolated. Among which, carbapenem-resistant Klebsiella pneumoniae strains constituted 32.3%. The primary sites of KPN detection were the respiratory tract (71.1%), blood (8.6%), and urinary tract (7.1%). KPN’s resistance to penicillin drugs exceeded 90%. The resistance rate to amoxicillin-clavulanic acid declined from 70–48%, whereas it remained relatively stable at approximately 31–33% for piperacillin-tazobactam. KPN’s resistance rates to cephalosporins exceeded 50%. The resistance rate to cefoperazone-sulbactam decreased from 51.7% in 2018 to 12.2% in 2021 before increasing to 25.7% in 2022. The resistance rates to ceftolozane-tazobactam in the preceding 3 years ranged from 9.1–20.8%. The resistance rates to imipenem and meropenem have gradually decreased to 33.8% and 40.2% in 2022, respectively, whereas the resistance rate to ertapenem has increased from 14.8–35.2%. The resistance rate of KPN gradually declined from 41.6–25.7% for levofloxacin, while remained considerably high at 63.8% and 44.6% for moxifloxacin and ciprofloxacin, respectively. The resistance rate of KPN to amikacin declined from 29.1–9.1%. KPN exhibited the greatest vulnerability to polymyxin B, tigecycline, and polymyxin E, with resistance rates of 0.9%, 2.2% and 3.1%, correspondingly. Cross-resistance analysis revealed that no KPN strain was resistant to both polymyxin B and meropenem. However, varying degrees of meropenem co-resistance were observed with tigecycline (2%), imipenem (16%), amikacin (27%), colistin (37%) and levofloxacin (41%), respectively. Conclusion The clinical isolation rate of KPN was significantly elevated in PICU. Additionally, there was a substantial rise in drug resistance rates over a span of 7 years. Consequently, it is imperative to emphasize the prudent utilization of antibiotics in pediatric patients, implement efficient infection control measures, and employ suitable combinations of antibiotics to effectively tackle this urgent matter.