93 Year: 2023 Volume: 4 Issue: 3 Journal of Pediatric Academy Original Article This Work Is Licensed Under A Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License © Copyright 2023 by the Kayseri Child Health Association. The Journal of Pediatric Academy published by Galenos Publishing House. J Pediatr Acad 2023; 4: 93-101 Bloodstream Infections by Extended- spectrum β-lactamase-producing Klebsiella Species in Children Cite this article as: Yahşi A, Arslan E, Atay BN, Gökdöl MY, Karaciğer S, Erat T, Konca HK, Özen S, Dinç B, Bayhan Gİ. Bloodstream Infections by Extended-spectrum β-lactamase-producing Klebsiella Species in Children. J Pediatr Acad 2023; 4: 93-101 Author(s) Aysun Yahşi 1 , Emel Arslan 2 , Beyza Nur Atay 2 , Muhammed Yasin Gökdöl 2 , Seren Karaciğer 2 , Tuğba Erat 1 , Hatice Kübra Konca 1 , Seval Özen 1 , Bedia Dinç 3 , Gülsüm İclal Bayhan 1 Affiliation(s) 1 Ankara City Hospital, Clinic of Pediatric Infectious Diseases, Ankara, Turkey 2 Ankara City Hospital, Clinic of Pediatrics, Ankara, Turkey 3 Ankara City Hospital, Clinic of Microbiology, Ankara, Turkey Article Information Article Type: Original Articles Article Group: Pediatric Infectious Diseases Received: 11.06.2023 Accepted: 02.08.2023 Epub: 17.08.2023 Available Online: 26.09.2023 Abstract Infections caused by resistant Gram-negative bacteria are a serious public health problem, with Klebsiella spp. being the most common cause and increasing over the years. There is a striking increase in antibiotic resistance worldwide. The aim of this study was to retrospectively evaluate the characteristics and treatment of bloodstream infections (BSIs) caused by Klebsiella spp. and to identify possible risk factors for extended-spectrum β-lactamase (ESBL) resistance in our hospital between August 2019 and March 2023. Of 250 Klebsiella isolates, 112 (44.8%) were ESBL producers and 138 (55.2%) were ESBL nonproducers. Catheter- related BSIs (CRBSIs) accounted for 49.6% of infections and were more common in the ESBL nonproducer group. Most of the Klebsiella spp. were K. pneumoniae (233/250). Most of the infections were healthcare-associated infections (85.6%). Most patients had an underlying disease, the most common underlying disease in the ESBL-producing group was neurometabolic disease (26.8%), whereas in the ESBL-non-producing group it was malignancy (35.5%). The median age of the ESBL-producing group was 14 months and was younger (p=0.01). Previous antibiotic use in the last 30 days, especially aminoglycosides (p<0.006), β-lactam-β-lactamase inhibitor combinations (p<0.001) and cephalosporins (p<0.001), increased ESBL-resistant infection. Use of β-lactam-β-lactamase inhibitor combinations in the last 30 days increased the risk of ESBL resistance by approximately 7.4 times, and cephalosporins increased the risk by 5 times. In the ESBL-producing group, the median duration of treatment was longer at 14 days (p=0.01), and carbapenems were most commonly used (p<0.001). Thrombocytopenia (p=0.003), elevated C-reactive protein (p<0.001), CRBSI (p=0.009), presence of central venous catheter (p=0.03), urinary catheter (p<0.001), mechanical ventilation (p<0.001), intensive care admission (p=0.005), previous use of carbapenems, aminoglycosides, fluoroquinolones in the last 30 days (p=0.003, p=0.001, p=0.006, respectively) and colistin treatment (p<0.001) increased the risk of mortality. The 28-day mortality rate was 11.6%. Appropriate use of narrow-spectrum antibiotics and reduction of invasive procedures is important in reducing ESBL resistance and BSI-related mortality. Keywords: Extended spectrum β-lactamase, Klebsiella pneumoniae, Klebsiella oxytoca, children Correspondence: Aysun Yahşi, Ankara City Hospital, Clinic of Pediatric Infectious Diseases, Ankara, Turkey E-mail: aysunyahsi@yahoo.com ORCID: 0000-0002-7245-2028 Doi: 10.4274/jpea.2023.238