Klebsiella pneumoniae bloodstream infections at a South African children's hospital 2006-2011, a cross-sectional study

Background: Klebsiella pneumoniae (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 Klebsiella pneumoniae bloodstream infection (KPBSI) at Red Cross War Memorial Children's Hospital, Cape Town, South Africa. Methods: We conducted a retrospective cross-sectional study of KPBSI from 1 January 2006 to 31 December 2011 using conventional descriptive and inferential statistical methods. Results: Of 410 hospitalised children with laboratory confirmed KPBSI, 339 (83 %) were caused by extended-spectrum beta-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. Conclusion: ESBL-producing KP is an important cause of laboratory confirmed bloodstream infection in hospitalised children and is associated with high mortality.