Time to appropriate antimicrobial therapy serves an independent prognostic indicator in children with nosocomial Klebsiella pneumoniae bloodstream infection

作者全名："Cheng, Jie; Li, Qinyuan; Zhang, Guangli; Xu, Huiting; Li, Yuanyuan; Tian, Xiaoyin; Chen, Dapeng; Luo, Zhengxiu"

作者地址："[Cheng, Jie] Chongqing Med Univ, Childrens Hosp,Key Lab Child Dev & Disorders, Natl Clin Res Ctr Child Hlth & Disorder, Chongqing Key Lab Pediat,Dept Emergency,Minist Ed, Chongqing 401122, Peoples R China; [Li, Qinyuan; Zhang, Guangli; Xu, Huiting; Li, Yuanyuan; Tian, Xiaoyin; Luo, Zhengxiu] Chongqing Med Univ, Childrens Hosp,Key Lab Child Dev & Disorders, Natl Clin Res Ctr Child Hlth & Disorder, Chongqing Key Lab Pediat,Dept Resp Med,Minist Edu, Chongqing 401122, Peoples R China; [Chen, Dapeng] Chongqing Med Univ, Childrens Hosp, Dept Clin Lab Ctr, Chongqing 401122, Peoples R China"

通信作者："Luo, ZX (通讯作者)，Chongqing Med Univ, Childrens Hosp,Key Lab Child Dev & Disorders, Natl Clin Res Ctr Child Hlth & Disorder, Chongqing Key Lab Pediat,Dept Resp Med,Minist Edu, Chongqing 401122, Peoples R China."

来源：BMC PEDIATRICS

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000863585500001

JCR分区：Q2

影响因子：2.4

年份：2022

卷号：22

期号：1

开始页：　

结束页：　

文献类型：Article

关键词：Klebsiella pneumoniae; Delayed therapy; Time to appropriate therapy; Nosocomial bloodstream infection; Children

摘要："We tend to investigate the connection between time to appropriate therapy (TTAT) and prognosis in pediatric patients with nosocomial Klebsiella pneumoniae (K. pneumoniae) bloodstream infection, and find the optimal cutoff point for the empirical administration of antimicrobials. This retrospective study was conducted in Children's Hospital of Chongqing Medical University, and inpatients with nosocomial K. pneumoniae bloodstream infection were finally enrolled. We applied the Classification and Regression Tree (CART) analysis to find the TTAT cutoff point and the Logistic Regression analysis to evaluate prognostic indicators. The incidence of septic shock and mortality was 17.91% (12/67) and 13.43% (9/67), respectively. The CART-derived TTAT cutoff point was 10.7 h. The multivariate logistic regression analysis indicated delayed therapy (TTAT >= 10.7 h), pediatric risk of mortality (PRISM) III scores >= 10, time to positivity (TTP) <= 13 h, and requiring for invasive mechanical ventilation were independently associated with the incidence of septic shock (Odds ratio [OR] 9.87, 95% Confidence interval [CI] 1.46-66.59, P = 0.019; OR 9.69, 95% CI 1.15-81.39, P = 0.036; OR 8.28, 95% CI 1.37-50.10, P = 0.021; OR 6.52, 95% CI 1.08-39.51, P = 0.042; respectively) and in-hospital mortality (OR 22.19, 95% CI 1.25-393.94, P = 0.035; OR 40.06, 95% CI 2.32-691.35, P = 0.011; OR 22.60, 95% CI 1.78-287.27, P = 0.016; OR 12.21, 95% CI 1.06-140.67, P = 0.045; respectively). Conclusions: TTAT is an independent predictor of poor outcomes in children with nosocomial K. pneumoniae bloodstream infection. Initial appropriate antimicrobial therapy should be administrated timely and within 10.7 h from the onset of bloodstream infection is recommended."

基金机构：Science and Technology Department of Chongqing [cstc2018jscx-msybX0021]

基金资助正文：This study was supported by the Science and Technology Department of Chongqing (cstc2018jscx-msybX0021).