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Background <p>The global rise of antimicrobial resistance has become a major public health concern. However, data on the clinical course and outcomes of infections caused by pandrug-resistant (PDR) bacteria in children remain limited. This study aimed to compare the clinical characteristics and treatment outcomes of PDR <i>Acinetobacter baumannii</i> and <i>Klebsiella pneumoniae</i> infections in pediatric patients.</p> Methods <p>We retrospectively analyzed pediatric cases with PDR <i>A. baumannii</i> and <i>K. pneumoniae</i> infections diagnosed between 2020 and 2023 in a tertiary-care center. Demographic characteristics, infection sites, clinical findings, and outcomes were compared between the two groups using appropriate statistical tests.</p> Results <p>PDR <i>K. pneumoniae</i> infections occurred in significantly younger children (<i>p</i> = 0.004). PDR <i>K. pneumoniae</i> episodes most commonly involved pneumonia (47.4%) or bloodstream infection (42.1%), with mortality rates of 15.8%. PDR <i>A. baumannii</i> episodes were most frequently associated with pneumonia (65.3%), with mortality rates of 7.7%. Recurrence rates were similar between the two groups (36.8% vs. 26.9%; <i>p</i> = 0.478), and none of the recurrent infections resulted in death. Fever duration was longer in the PDR <i>A. baumannii</i> group (<i>p</i> = 0.009), whereas co-infections and complications were numerically more frequent but did not reach statistical significance (respectively; <i>p</i> = 0.06 and <i>p</i> = 0.08). Ceftazidime-avibactam (CZA) resistance was observed in 63.2% of PDR <i>K. pneumoniae</i> isolates, and all recurrent PDR <i>K. pneumoniae</i> episodes were CZA-resistant; no deaths occurred among recurrent episodes in either group.</p> Conclusions <p>PDR <i>A. baumannii</i> and <i>K. pneumoniae</i> infections showed comparable severity and mortality in children, although <i>K. pneumoniae</i> affected younger patients and <i>A. baumannii</i> was associated with longer fever duration. Both pathogens were typically identified after prolonged hospitalization and were closely linked to intensive care exposure. The high rate of CZA resistance among PDR <i>K. pneumoniae</i> isolates, including all recurrent PDR <i>K. pneumoniae</i> episodes, was a clinically important finding that may further limit therapeutic options.</p> Clinical trial number <p>Not applicable.</p>

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Comparative clinical outcomes of pandrug-resistant Acinetobacter baumannii and Klebsiella pneumoniae infections in children

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月4日

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  • İrem Ceren Erbaş,
  • Şilem Özdem Alataş,
  • Ayşe Çakıl Güzin,
  • Hatice Karaoğlu Asrak,
  • Elif Alaçam,
  • Ayşen Hazal Buran,
  • Mahmut Cem Ergon,
  • Nurşen Belet

摘要

Background

The global rise of antimicrobial resistance has become a major public health concern. However, data on the clinical course and outcomes of infections caused by pandrug-resistant (PDR) bacteria in children remain limited. This study aimed to compare the clinical characteristics and treatment outcomes of PDR Acinetobacter baumannii and Klebsiella pneumoniae infections in pediatric patients.

Methods

We retrospectively analyzed pediatric cases with PDR A. baumannii and K. pneumoniae infections diagnosed between 2020 and 2023 in a tertiary-care center. Demographic characteristics, infection sites, clinical findings, and outcomes were compared between the two groups using appropriate statistical tests.

Results

PDR K. pneumoniae infections occurred in significantly younger children (p = 0.004). PDR K. pneumoniae episodes most commonly involved pneumonia (47.4%) or bloodstream infection (42.1%), with mortality rates of 15.8%. PDR A. baumannii episodes were most frequently associated with pneumonia (65.3%), with mortality rates of 7.7%. Recurrence rates were similar between the two groups (36.8% vs. 26.9%; p = 0.478), and none of the recurrent infections resulted in death. Fever duration was longer in the PDR A. baumannii group (p = 0.009), whereas co-infections and complications were numerically more frequent but did not reach statistical significance (respectively; p = 0.06 and p = 0.08). Ceftazidime-avibactam (CZA) resistance was observed in 63.2% of PDR K. pneumoniae isolates, and all recurrent PDR K. pneumoniae episodes were CZA-resistant; no deaths occurred among recurrent episodes in either group.

Conclusions

PDR A. baumannii and K. pneumoniae infections showed comparable severity and mortality in children, although K. pneumoniae affected younger patients and A. baumannii was associated with longer fever duration. Both pathogens were typically identified after prolonged hospitalization and were closely linked to intensive care exposure. The high rate of CZA resistance among PDR K. pneumoniae isolates, including all recurrent PDR K. pneumoniae episodes, was a clinically important finding that may further limit therapeutic options.

Clinical trial number

Not applicable.