Time to positivity of Klebsiella pneumoniae in blood culture as prognostic indicator for pediatric bloodstream infection
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ORIGINAL ARTICLE
Time to positivity of Klebsiella pneumoniae in blood culture as prognostic indicator for pediatric bloodstream infections Jie Cheng 1,2 & Guangli Zhang 3 & Qingyuan Li 1,2 & Huiting Xu 1,2 & Qinghong Yu 1,2 & Qian Yi 1,2 & Siying Luo 1,2 & Yuanyuan Li 3 & Xiaoyin Tian 3 & Dapeng Chen 4 & Zhengxiu Luo 3 Received: 12 November 2019 / Revised: 25 April 2020 / Accepted: 1 May 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract The aim of this study is to explore the prognostic values and optimal cutoff point of time to positivity (TTP) of blood culture in children with Klebsiella pneumoniae (K. pneumoniae) bloodstream infection. Ninety-four children with K. pneumoniae bloodstream infection hospitalized in Children’s Hospital of Chongqing Medical University from April 2014 to January 2019 were enrolled retrospectively. TTP and risk factors were determined and analyzed by receiver operating characteristic (ROC) analysis and logistic regression analysis. The standard cutoff point of TTP was 13 h. Patients in early TTP (≤ 13 h) group had significantly higher in-hospital mortality (37.93% vs 6.15%, P = 0.000), higher incidence of septic shock (44.83% vs 6.15%, P = 0.000), higher proportion of PRISM III scores ≥ 10 (48.28% vs 20.00%, P = 0.005), and higher proportion of hypoalbuminemia on admission (44.83% vs 18.46%, P = 0.008). Multivariate analysis indicated PRISM III scores ≥ 10, early TTP, and hypoalbuminemia on admission were independent risk factors of in-hospital mortality (OR 8.36, 95% CI 1.80–38.92, P = 0.007; OR 5.85, 95% CI 1.33–25.61, P = 0.019; OR 5.73, 95% CI 1.30–25.22, P = 0.021, respectively) and septic shock (OR 14.04, 95% CI 2.63–75.38, P = 0.002; OR 11.26, 95% CI 2.10–60.22, P = 0.005; OR 10.27, 95% CI 2.01–52.35, P = 0.005, respectively). Conclusion: Early TTP (TTP ≤ 13 h), PRISM III scores ≥ 10, and hypoalbuminemia on admission appeared to be associated with worse outcomes for K. pneumoniae bloodstream infection children. What is Known: • Klebsiella pneumoniae bloodstream infection is an important cause of infectious disease morbidity and mortality worldwide in children. • Short duration of time to positivity indicated poor clinical outcomes. What is New: • Time to positivity ≤ 13 h, along with PRISM III scores ≥ 10 and hypoalbuminemia on admission, indicated higher in-hospital mortality and incidence of septic shock in Klebsiella pneumoniae bloodstream infection children. • The cut-off point of TTP in this pediatric study was much longer than that reported in adult patients.
Keywords Time to positivity . Blood culture . Klebsiella pneumoniae . Bloodstream infection . Outcomes . Children Communicated by Nicole Ritz * Zhengxiu Luo [email protected]
Qian Yi [email protected]
Jie Cheng [email protected]
Siying Luo [email protected]
Guangli Zhang [email protected] Qingyuan Li [email protected] Huiting Xu [email protected] Qinghong Yu [email protected]
Yuanyuan Li [email protected] Xiaoyin Tian [email protected] Dapeng Chen [email protected] Extended auth
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