Time to Appropriate Antibiotic Therapy is an Independent Indicator of Poor Outcome in Children with Nosocomial Klebsiella Pneumoniae Bloodstream Infection
Abstract We aim to evaluate the effects of time to appropriate therapy (TTAT) on outcomes in children with nosocomial K. pneumoniae bloodstream infection, and to find an optimal time window for empiric antibiotics administration. Children with nosocomial K. pneumoniae bloodstream infection hospitalized in Children’s Hospital of Chongqing Medical University from April 2014 to December 2019 were enrolled retrospectively. TTAT cutoff point and risk factors were determined and analyzed by Classification and Regression Tree (CART) analysis and Logistic Regression analysis. Overall, sixty-seven patients were enrolled. The incidence of septic shock and mortality was 17.91% (12/67) and 13.43% (9/67), respectively. The CART-derived TTAT cutoff point was 10.7 hours. The multivariate logistic regression analysis indicated delayed therapy (TTAT ≥ 10.7 h), PRISM III scores ≥ 10, early TTP (TTP ≤ 13 h), and need for invasive mechanical ventilation were independent risk factors of septic shock (OR 9.87, 95% CI 1.46-66.59, P = 0.019; OR 9.69, 95% CI 1.15-81.39, P = 0.036; OR 8.28, 95% CI 1.37-50.10, P = 0.021; OR 6.52, 95% CI 1.08-39.51, P = 0.042; respectively) and in-hospital mortality (OR 22.19, 95% CI 1.25-393.94, P = 0.035; OR 40.06, 95% CI 2.32-691.35, P = 0.011; OR 22.60, 95% CI 1.78-287.27, P = 0.016; OR 12.21, 95% CI 1.06-140.67, P = 0.045; respectively). Conclusions: TTAT is an independent predictor of poor outcome in children with nosocomial K. pneumoniae bloodstream infection. Initial appropriate antibiotic therapy should begin within 10.7 hours from the onset of bloodstream infection.