title: Klebsiella pneumoniae bloodstream infections at a South African children's hospital 2006-2011, a cross-sectional study.
abstract: 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 β-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.
  
  
  CONCLUSIONS
  ESBL-producing KP is an important cause of laboratory confirmed bloodstream infection in hospitalised children and is associated with high mortality.
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Klipfontein Road, Cape Town, Rondebosch, 7700, South Africa. heloise.buys@uct.ac.za.|University of Cape Town, Cape Town, South Africa. heloise.buys@uct.ac.za.|Ambulatory and Emergency Paediatrics, Red Cross War Memorial Children's Hospital, Klipfontein Road, Cape Town, Rondebosch, 7700, South Africa. heloise.buys@uct.ac.za.
authors.forename: Heloise
authors.initials: H
authors.lastname: Buys
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Klipfontein Road, Cape Town, Rondebosch, 7700, South Africa.|University of Cape Town, Cape Town, South Africa.
authors.forename: Rudzani
authors.initials: R
authors.lastname: Muloiwa
authors.affiliation: University of Cape Town, Cape Town, South Africa.|National Health Laboratory Service (Groote Schuur Hospital), Cape Town, South Africa.
authors.forename: Colleen
authors.initials: C
authors.lastname: Bamford
authors.affiliation: Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, Klipfontein Road, Cape Town, Rondebosch, 7700, South Africa.|University of Cape Town, Cape Town, South Africa.
authors.forename: Brian
authors.initials: B
authors.lastname: Eley
mesh_terms: D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002511:Cephalosporins / Q000627:therapeutic use; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000453:epidemiology; D003428:Cross Infection / Q000453:epidemiology; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial / Q000187:drug effects; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000382:microbiology; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007710:Klebsiella Infections / Q000188:drug therapy* / Q000453:epidemiology* / Q000401:mortality; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000378:metabolism / Q000472:pathogenicity; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D002511:Cephalosporins; D001618:beta-Lactamases
keywords: Africa; Children; Klebsiella pneumoniae bloodstream infection