Uncovering the risk factors for mortality of carbapenem-resistant Klebsiella pneumoniae infections in Indonesian NICU: A study from a referral hospital

Background Carbapenem-resistant K. pneumoniae (CRKP) presents a significant challenge for infection control and treatment in the neonatal population. The aim of the study is to identify risk factors associated with mortality of in neonates infected with CRKP in the NICU. Methods We conducted a retrospective review of medical records from January to December 2018, including all neonates with positive K. pneumoniae blood cultures. Possible risk factors such as birth weight, gestational age, length of stay, episodes of sepsis, use of mechanical ventilation, parenteral nutrition, central access, blood transfusion, laboratory values, and prior antibiotics use before isolation were recorded. Results Of 402 neonates clinically diagnosed with sepsis, 50 had positive K. pneumoniae cultures, with 80% identified as CRKP. Among CRKP cases, mortality was associated with PRC transfusion (100% vs 46.2%; RR 5.5; 95% CI 2.67–11.34; p < 0.001), elevated inflammatory markers (CRP: 58.2 vs 27.75 mg/dL, p = 0.01; PCT: 21.99 vs 2.63 ng/mL, p = 0.03), and prior carbapenem use (77.8% vs 38.5%; RR 5.6; 95% CI 1.33–23.62; p = 0.03). Conclusion The study highlights that a majority of neonatal sepsis cases caused by Klebsiella pneumoniae in the Indonesian NICU were due to carbapenem-resistant strains (CRKP). CRKP infection was significantly associated with higher mortality, particularly among neonates who had received packed red cell transfusions, showed elevated inflammatory markers, or had prior exposure to carbapenem antibiotics. These findings underscore the urgent need for enhanced infection control measures, judicious antibiotic use, and targeted interventions to reduce mortality from CRKP in neonatal care settings.