PREDICTORS AND CLINICAL CHARACTERISTICS OF THIRD-GENERATION CEPHALOSPORIN RESISTANTKLEBSIELLA PNEUMONIAE BLOODSTREAM INFECTIONS IN PEDIATRIC PATIENTS ADMITTED TO HIWOT FANA COMPREHENSIVE SPECIALIZED HOSPITALIN 2021: A NESTED CASE-CONTROL STUDY.

Abstract

Background: Antimicrobial resistance is a global health threat, with an increasing burden of drug-resistant infections, especially insub-Saharan Africa.Third-generation cephalosporin resistantKlebsiella pneumoniae (3GCR-KP) is a bacterial pathogen that causes bloodstream infections (BSI) with adverse clinical outcomes.In Ethiopia, post-mortem analysis of patient samples revealed that 3GCR-KP is a major pathogen causing neonatal and child mortality.However, few studies have investigated the predictors of 3GCR-KP BSI in pediatric patients. Objective: This study aimed to describe the clinical characteristics and identify predictors of 3GCR-KP BSI in pediatric patients admitted to Hiwot Fana Comprehensive Specialized Hospital (HFCSH) in 2021. Methods: A matched nested case-control study was conducted using data extracted from the records of a cohort study named MBIRA (Mortality from Bacterial Infections Resistant to Antibiotics) conducted in HFCSH. Cases were defined as patients with blood culture-proven 3GCR-KP BSI, and 3GCR was defined as laboratory-confirmed resistance to cefotaxime.Controls were individually-matched uninfected patients who were randomly selected from the same hospital.The matching variables were age, ward, date of admission, and time in hospital.Data were summarized as frequencies, medians, and interquartile ranges, and associations were identified using bivariate analysis.A multivariable conditional logistic regression model was used to identify the predictors of outcome status. Results: This study included 406 patients (140 cases and 266 controls). BSI cases were characterized by higher proportions of previous hospital admission 20.0% (28/140), comorbid illnesses 38.6% (54/140), and malnutrition 52.9% (74/140)compared to uninfected controls 12.0% (32/266), 30.8% (52/266), 38.4% (102/266), respectively. Underweight children had approximately two-fold higher odds of outcome than children with normal nutritional status (Odds Ratio [OR]=1.86; 95% confidence interval [CI] 1.08-3.19, p=0.024).Patients who had anNGT had approximately three-fold higher odds of outcome than those who did not use such a device (OR=2.75, 95%CI 1.60-4.72, p<0.001). Conclusion: The presence of NGT and malnutrition in hospitalized pediatric patients can predict the presence of 3GCR-KP BSI.This could help identify patients with a high probability of such infections and prioritize them for blood culture testing and treatment with second-line antibiotics, which could in turn slow the spread of such resistant pathogens.