Risk Factors for Mortality and Antimicrobial Regimens in Pediatric Intensive Care Unit Patients with Carbapenem-Resistant Enterobacteriaceae Infections: A Six-Year Retrospective Study

Figures & data

Table 1 Patient Characteristics

Characteristic	Total (n = 56)	Deceased (n = 28)	Survived (n = 28)	P
Age (year)	10.0 (2.7–11.7)	10.7 (3.7–12.5)	7.5 (2.2–10.9)	0.272
Weight (kg)	28.0 (14.0–41.8)	33.0 (17.3–41.8)	20.5 (13.0–46.0)	0.486
Male (%)	39 (69.6%)	22 (78.6%)	17 (60.7%)	0.146
PCIS	88.0 (80.5–92.0)	84.0 (78.0–90.0)	92.0 (86.5–96.0)	<0.001
PIM3 score	−2.6 (−3.6– −2.0)	−2.4 (−3.2– −1.7)	−2.8 (−4.2– −2.1)	0.098
Probability of death	6.9 (2.6–12.1)	8.7 (4.1–16.0)	5.5 (1.5–10.8)	0.098
PRISM III score	12.0 (7.3–16.8)	15.0 (12.0–18.0)	9.0 (5.0–12.0)	0.003
Septic shock, n (%)	13 (23.2%)	7 (25.0%)	6 (21.4%)	0.752
MODS, n (%)	18 (32.1%)	12 (42.9%)	6 (21.4%)	0.086
Mechanical ventilation, n (%)	20 (35.7%)	8 (28.6%)	12 (42.9%)	0.265
CPR, n (%)	8 (14.3%)	4 (14.3%)	4 (14.3%)	1.0
Surgery, n (%)	10 (17.9%)	5 (17.9%)	5 (17.9%)	1.0
Underlying disease, n (%)
Hematological system disease	29 (51.8%)	19 (67.9%)	10 (35.7%)	0.016
Accidental injury	8 (14.3%)	1 (3.6%)	7 (25.0%)	0.051
Congenital malformation	7 (12.5%)	1 (3.6%)	6 (21.4%)	0.101
Immunodeficiency	3 (5.4%)	2 (7.1%)	1 (3.6%)	0.553
Others	9 (16.1%)	5 (17.9%)	4 (14.3%)	0.716
Immunosuppression, n (%)	38 (67.9%)	22 (78.6%)	16 (42.1%)	0.086
Invasive procedures, n (%)
Central venous catheterization	40 (71.4%)	19 (67.9%)	21 (75.0%)	0.554
Urinary catheterization	27 (48.2%)	11 (39.3%)	16 (57.1%)	0.181
Gastric catheterization	33 (58.9%)	13 (46.4%)	20 (71.4%)	0.057
Infection sites, n=68(%)
Bloodstream	29 (51.8%)	16 (57.1%)	13 (46.4%)	0.422
Pulmonary	27 (48.2%))	12 (42.9%)	15 (53.6%)	0.522
Intraperitoneal	5 (8.9%)	1 (3.6%)	4 (14.3%)	0.160
Others	7 (12.5%)	4 (14.3%)	3 (10.07%)	0.686
Meropenem MIC (mg/L)
≥ 16	48 (85.7%)	24 (85.7%)	24 (85.7%)	0.766
4–8	3 (5.4%)	1 (3.6%)	2 (7.1%)
≤2	5 (8.9%)	3 (10.7%)	2 (7.1%)
Multi-site infection, n (%)	12 (21.4%)	5 (17.9%)	7 (25.0%)	0.515
Serum albumin	32.3 (27.6–36.8)	28.1 (25.2–33.6)	34.3 (29.5–38.8)	0.001
Creatinine	27.0 (16.3–40.5)	36.5 (18.3–54.0)	24.4 (16.0–34.5)	0.037
Lactate dehydrogenase	383.0(176.3–789.8)	471.0(215.5–852.8)	291.0(163.5–762.0)	0.334
Alamine aminotransferase	41.0 (18.3–66.8)	41.0 (14.0–98.5)	41.5 (21.3–59.5)	0.670
Total bilirubin	14.8 (6.8–49.3)	16.6 (7.4–70.6)	13.4 (6.3–32.2)	0.248
White blood cells	5.7 (0.3–12.4)	1.5 (0.2–11.3)	9.3 (0.3–13.0)	0.127
Hemoglobin	85.5 (74.2–95.7)	79.2 (70.3–94.5)	89.5 (76.2–96.8)	0.108
Platelet	49.5 (7.3–201.3)	28.5 (5.5–123.3)	143.0 (28.5–295.8)	0.006
C-reactive protein	120.0 (46.4–200.0)	168.1 (87.4–200.0)	95.7 (34.5–164.8)	0.043
Procalcitonin	2.5 (0.4–9.4)	4.6 (0.6–16.4)	1.1 (0.3–4.6)	0.068

Note: Categorical variables were presented as numbers (%), and continuous variables were presented as median (interquartile ranges).

Abbreviations: PCIS, pediatric critical illness score; PIM, paediatric index of mortality; PRISM, pediatric risk of mortality score; MODS, multiple organ dysfunction syndrome; CPR, cardiopulmonary resuscitation.

Figure 1 Flow chart of included patients with CRE infections. CRE, carbapenem-resistant Enterobacteriaceae; PICU, pediatric intensive care unit.

Figure 2 Cox regression of factors associated with 30-day mortality. HR, hazard ratio; CI, confidence interval; PCIS, pediatric critical illness score; MODS, multiple organ dysfunction syndrome.

Figure 3 The area under the area under the curve of risk factor for the survive of CRE infections. CRE, carbapenem-resistant Enterobacteriaceae; PCIS, pediatric critical illness score.

Table 2 Comparison of Characteristics and Treatment Between Patient with and without Polymyxin B

Characteristic	With Polymyxin B (n = 28)	Without Polymyxin B (n = 22)	P
Age (year)	9.8 (4.1–12.6)	9.9 (1.3–11.3)	0.197
Weight (kg)	32.0 (17.3–47.5)	23.3 (9.8–38.5)	0.120
Male (%)	19 (67.9%)	15 (68.2%)	0.981
PCIS	90.0 (86.0–93.5)	86.0 (80.0–96.0)	0.530
PIM3 score	−2.8 (−3.5– −2.2)	−2.6 (−4.2– −1.5)	0.845
Probability of death	5.9 (2.9–10.4)	7.3 (1.5–18.1)	0.845
PRISM III	12.0 (7.5–17.5)	11.5 (8.0–15.0)	0.583
Septic shock, n (%)	6 (21.4%)	5 (22.7%)	0.912
MODS, n (%)	12 (42.9%)	4 (18.2%)	0.076
Mechanical ventilation, n (%)	13 (46.4%)	7 (31.8%)	0.295
CPR, n (%)	5 (17.9%)	3 (13.6%)	1.0
Surgery, n (%)	4 (14.3%)	5 (22.7%)	0.481
Underlying disease, n (%)
Hematological system disease	16 (57.1%)	9 (40.9%)	0.254
Accidental injury	3 (10.7%)	5 (22.7%)	0.277
Congenital malformation	2 (7.1%)	5 (22.7%)	0.217
Immunodeficiency	1 (12.5%)	0	0.371
Others	6 (21.4%)	3 (13.6%)	0.476
Immunosuppression, n (%)	20 (71.4%)	12 (54.5%)	0.217
Invasive procedures, n (%)
Central venous catheterization	22 (78.6%)	15 (68.2%)	0.406
Urinary catheterization	18 (64.3%)	8 (36.4%)	0.050
Gastric catheterization	21 (75.0%)	11 (50.0%)	0.068
Infection sites, n=68 (%)
Bloodstream	16 (57.1%)	8 (36.4%)	0.144
Pulmonary	13 (46.4%)	14 (63.6%)	0.226
Intraperitoneal	4 (14.3%)	1 (4.5%)	0.254
Others	3 (10.7%)	3 (13.6%)	0.752
Meropenem MIC (mg/L)
≥ 16	23 (82.1%)	19 (86.4%)	0.906
4–8	2 (7.1%)	1 (4.5%)
≤2	3 (10.7%)	2 (9.1%)
Multisite infection, n (%)	8 (28.6%)	4 (18.2%)	0.512
Serum Albumin	32.2 (28.1–37.5)	33.0 (27.4–35.9)	0.977
Creatinine	27.5 (18.0–50.9)	25.5 (15.5–46.3)	0.358
Lactate dehydrogenase	342.0(194.3–805.5)	455.5(161.8–813.3)	0.860
Alamine aminotransferase	35.0 (15.5–57.5)	56.0 (21.0–68.8)	0.168
Total bilirubin	13.2 (6.8–37.5)	14. 5(6.1–33.5)	0.845
White blood cells	6.0 (0.3–14.2)	6.0 (0.3–11.9)	0.710
Hemoglobin	83.0 (77.8–96.5)	87.7 (70.8–100.0)	0.914
Platelet	56.5 (8.0–197.5)	57.0 (10.3–242.0)	0.625
C-reactive protein	106.2(43.6–200.0)	114.1 (38.2–200.0)	0.761
Procalcitonin	2.3 (0.4–7.7)	0.9 (0.3–15.4)	0.558
Deceased, n (%)	12 (42.9%)	10 (45.5%)	0.854

Note: Categorical variables were presented as numbers (%), and continuous variables were presented as median (interquartile ranges).

Abbreviations: PCIS, pediatric critical illness score; PIM, paediatric index of mortality; PRISM, pediatric risk of mortality score; MODS, multiple organ dysfunction syndrome; CPR, cardiopulmonary resuscitation.

Table 3 The Impacts of Different Therapy on the 30-Day Mortality

Antimicrobial Regimen	No.	Deceased (%)	P	Efficiency (%)	P
With polymyxin B	28	12 (42.9%)	0.854	15 (53.4%)	0.374
+Carbapenem	23	11		11
+Carbapenem+Tigecycline	1	0		1
+Tigecycline	1	0		1
+Cefperazone/Sulbactam	2	1		1
Monotherapy	1	0		1
Without polymyxin B	22	10 (45.5%)		9 (40.9%)
Carbapenem	14	5		6
Cefoperazone/Avibatam	2	1		2
Cefoperazone/Avibatam+Carbapenem	1	1		0
Cefperazone/Sulbactam+Tigecycline	2	2		0
Cefperazone/Sulbactam	1	1		0
Carbapenem+Cefperazone/Sulbactam	1	0		0
Carbapenem+Tigecycline	1	0		1

Figure 4 Survival rates of patients treated with polymyxin B and without polymyxin B.