Analysis of risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infections in children: a case-control study

Objective To analyze the risk factors for carbapenem-resistant Klebsiella pneumoniae bloodstream infection (CRKP-BSI) in children. Methods A total of 235 pediatric patients with Klebsiella pneumoniae bloodstream infection (KPN-BSI) admitted to our hospital from January 2015 to December 2025 were collected. According to the CLSI criteria, infections in which carbapenem- resistant Klebsiella pneumoniae was isolated from blood culture were defined as CRKP-BSI ( n =110), and those in which carbapenem-susceptible Klebsiella pneumoniae was isolated were defined as CSKP-BSI ( n =125). We compared clinical profiles of the two groups with the Mann-Whitney U test and chi-square test, and binary logistic regression was used to identify independent risk factors for CRKP-BSI. Results Children with CRKP-BSI were mainly distributed in the Premature Infant Department (49 cases, 44.60 %) and intensive care unit (36 cases, 32.70 %). Analysis of clinical characteristics showed that patient age, underlying diseases, antibiotic use duration ≥ 14 days, mechanical ventilation, surgical procedures during hospitalization, and hospital stay > 5 days were significantly associated with CRKP-BSI (all P < 0.05). Binary logistic regression multivariate analysis demonstrated that the mechanical ventilation ( β = 2.896, OR = 18.106), surgical procedures during hospitalization ( β = 1.116, OR = 3.052), and hospital stay > 5 days ( β = 0.957, OR = 2.603) were independently associated with CRKP-BSI. Conclusion It is concluded that mechanical ventilation, surgical interventions and prolonged hospitalization independently contribute to the development of CRKP-BSI in children. Enhanced monitoring and precise infection control strategies are required for vulnerable children to prevent CRKP-BSI.