OBJECTIVE To explore the clinical characteristics and associated risk factors of carbapenem-resistant Klebsiella pneumoniae (CRKP) infection in children in the pediatric intensive care unit (PICU), and to provide a theoretical basis for formulating precise prevention and control strategies.

METHODS A retrospective cohort design was employed, including 165 children infected with K. pneumoniae admitted to the PICU of the Maternity and Child Health Care of Guangxi Zhuang Autonomous Region from Jan. 2017 to Dec. 2024. Based on the results of antimicrobial susceptibility testing, the children were divided into the CRKP group (n=39) and the carbapenem-sensitive K. pneumoniae (CSKP) group (n=126). The clinical characteristics of the two groups were compared, and univariate and multivariate logistic regression models were constructed to analyze the risk factors for CRKP infection.

RESULTS The CRKP strains were primarily isolated from lower respiratory tract specimens, including 17 strains (43.59%) from sputum specimens and 11 strains (28.21%) from bronchoalveolar lavage fluid specimens. In terms of concurrent cardiovascular diseases, mechanical ventilation, central venous catheterization, use of carbapenems and premature birth, the proportion of children in the CRKP group was higher than that in the CSKP group (P < 0.05). Logistic regression analysis revealed that the use of carbapenems (OR=2.575, P=0.040) and premature birth (OR=2.383, P=0.046) were risk factors for CRKP infection in children admitted to the PICU.

CONCLUSIONS The CRKP infection in children in the PICU is closely related to the choice of carbapenems and premature birth. Clinically, measures such as graded management of antimicrobial drugs, active screening for premature infants, and enhanced contact isolation should be implemented to reduce the risk of CRKP infection.