Infections with Klebsiella pneumoniae in Children Undergoing Anticancer Therapy or Hematopoietic Cell Transplantation: A Multicenter Nationwide Study

Alicja Sękowska¹, Krzysztof Czyżewski^{2

3}, Kamila Jaremek², Patrycja Zalas-Więcek¹, Olga Zając-Spychała³, Jacek Wachowiak³, Anna Szmydki-Baran⁴, Łukasz Hutnik⁴, Agnieszka Gietka⁵, Olga Gryniewicz-Kwiatkowska⁵, Bożenna Dembowska-Bagińska⁵, Katarzyna Semczuk⁶, Katarzyna Dzierżanowska-Fangrat⁶, Wojciech Czogała⁷, Walentyna Balwierz⁷, Iwona Żak⁸, Renata Tomaszewska⁹, Tomasz Szczepański⁹, Ewa Bień¹⁰, Ninela Irga-Jaworska¹⁰, Katarzyna Machnik¹¹, Justyna Urbańska-Rakus¹¹, Sonia Pająk¹¹, Marcin Płonowski¹², Maryna Krawczuk-Rybak¹², Aleksandra Królak¹³, Tomasz Ociepa¹³, Tomasz Urasiński¹³, Paweł Wawryków¹⁴, Jarosław Peregud-Pogorzelski¹⁴, Tomasz Brzeski^{15

16}, Katarzyna Mycko^{15

16}, Hanna Mańko-Glińska^{15

16}, Wanda Badowska^{15

16}, Agnieszka Urbanek-Dądela¹⁷, Grażyna Karolczyk¹⁷, Weronika Stolpa¹⁸, Katarzyna Skowron-Kandzia¹⁸, Agnieszka Mizia-Malarz¹⁸, Filip Pierlejewski¹⁹, Wojciech Młynarski¹⁹, Jakub Musiał²⁰, Radosław Chaber²⁰, Joanna Zawitkowska²¹, Agnieszka Zaucha-Prażmo²¹, Katarzyna Drabko²¹, Jolanta Goździk²², Jowita Frączkiewicz²³, Małgorzata Salamonowicz-Bodzioch²³, Krzysztof Kałwak²³, Jan Styczyński²

Affiliations

¹ Microbiology Department, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland.
² Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland.
³ Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, 61-701 Poznan, Poland.
⁴ Department of Oncology, Pediatric Hematology, Clinical Transplantation and Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland.
⁵ Department of Oncology, Children's Memorial Health Institute, 04-730 Warsaw, Poland.
⁶ Department of Clinical Microbiology and Immunology, Children's Memorial Health Institute, 04-730 Warsaw, Poland.
⁷ Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland.
⁸ Department of Microbiology, University Children's Hospital, 30-663 Krakow, Poland.
⁹ Department of Pediatric Hematology and Oncology, Silesian Medical University, 41-808 Zabrze, Poland.
¹⁰ Department of Pediatrics, Hematology and Oncology, Medical University, 80-210 Gdansk, Poland.
¹¹ Division of Pediatric Hematology and Oncology, Chorzow City Hospital, 41-500 Chorzow, Poland.
¹² Department of Pediatric Oncology and Hematology, Medical University, 15-089 Bialystok, Poland.
¹³ Department of Pediatrics, Pediatric Hematooncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland.
¹⁴ Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, 70-204 Szczecin, Poland.
¹⁵ Department of Clinical Pediatrics University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland.
¹⁶ Clinical Divison of Pediatric Oncology and Hematology, Regional Specialised Children's Hospital in Olsztyn, 10-561 Olsztyn, Poland.
¹⁷ Division of Pediatric Hematology and Oncology, Children Hospital, 25-736 Kielce, Poland.
¹⁸ Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, 40-055 Katowice, Poland.
¹⁹ Department of Pediatrics, Hematology and Oncology, Medical University, 90-419 Lodz, Poland.
²⁰ Department of Pediatric Oncohematology, Medical Faculty University of Rzeszow, Clinical Provincial Hospital No. 2, 35-301 Rzeszow, Poland.
²¹ Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-059 Lublin, Poland.
²² Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, 31-008 Krakow, Poland.
²³ Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, 50-367 Wrocław, Poland.

PMID: 39064118
PMCID: PMC11277684
DOI: 10.3390/jcm13144078

Infections with Klebsiella pneumoniae in Children Undergoing Anticancer Therapy or Hematopoietic Cell Transplantation: A Multicenter Nationwide Study

Alicja Sękowska et al. J Clin Med. 2024.

. 2024 Jul 12;13(14):4078.

doi: 10.3390/jcm13144078.

Authors

Affiliations

¹ Microbiology Department, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland.
² Department of Pediatrics, Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University in Torun, 85-094 Bydgoszcz, Poland.
³ Department of Pediatric Oncology, Hematology and Transplantology, University of Medical Sciences, 61-701 Poznan, Poland.
⁴ Department of Oncology, Pediatric Hematology, Clinical Transplantation and Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland.
⁵ Department of Oncology, Children's Memorial Health Institute, 04-730 Warsaw, Poland.
⁶ Department of Clinical Microbiology and Immunology, Children's Memorial Health Institute, 04-730 Warsaw, Poland.
⁷ Department of Pediatric Oncology and Hematology, Institute of Pediatrics, Jagiellonian University Medical College, 31-008 Krakow, Poland.
⁸ Department of Microbiology, University Children's Hospital, 30-663 Krakow, Poland.
⁹ Department of Pediatric Hematology and Oncology, Silesian Medical University, 41-808 Zabrze, Poland.
¹⁰ Department of Pediatrics, Hematology and Oncology, Medical University, 80-210 Gdansk, Poland.
¹¹ Division of Pediatric Hematology and Oncology, Chorzow City Hospital, 41-500 Chorzow, Poland.
¹² Department of Pediatric Oncology and Hematology, Medical University, 15-089 Bialystok, Poland.
¹³ Department of Pediatrics, Pediatric Hematooncology and Gastroenterology, Pomeranian Medical University, 70-204 Szczecin, Poland.
¹⁴ Department of Pediatrics, Pediatric Oncology and Immunology, Pomeranian Medical University, 70-204 Szczecin, Poland.
¹⁵ Department of Clinical Pediatrics University of Warmia and Mazury in Olsztyn, 10-561 Olsztyn, Poland.
¹⁶ Clinical Divison of Pediatric Oncology and Hematology, Regional Specialised Children's Hospital in Olsztyn, 10-561 Olsztyn, Poland.
¹⁷ Division of Pediatric Hematology and Oncology, Children Hospital, 25-736 Kielce, Poland.
¹⁸ Division of Pediatric Oncology, Hematology and Chemotherapy, Department of Pediatric, Silesian Medical University, 40-055 Katowice, Poland.
¹⁹ Department of Pediatrics, Hematology and Oncology, Medical University, 90-419 Lodz, Poland.
²⁰ Department of Pediatric Oncohematology, Medical Faculty University of Rzeszow, Clinical Provincial Hospital No. 2, 35-301 Rzeszow, Poland.
²¹ Department of Pediatric Hematology, Oncology and Transplantology, Medical University of Lublin, 20-059 Lublin, Poland.
²² Stem Cell Transplant Center, University Children's Hospital, Department of Clinical Immunology and Transplantology, Jagiellonian University Collegium Medicum, 31-008 Krakow, Poland.
²³ Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, 50-367 Wrocław, Poland.

PMID: 39064118
PMCID: PMC11277684
DOI: 10.3390/jcm13144078

Abstract

Background:Klebsiella pneumoniae is a nosocomial pathogen that causes severe infections in immunocompromised patients. The aim of the study was to conduct a microbiological and clinical analysis of K. pneumoniae infections in children with malignancies or undergoing hematopoietic cell transplantation in Poland. Methods: We conducted a retrospective, multicenter study including children and adolescents under 19 years old treated between 2012 and 2021. We analyzed patients' characteristics, microbiological data, and the outcomes of antibiotic therapy. Results: A total of 9121 newly diagnosed children were treated for malignancy and 1697 pediatric patients underwent hematopoietic cell transplantation. K. pneumoniae infections were diagnosed in 527 patients. Their overall incidence was 4.86% in pediatric hematology and oncology patients and 4.95% in patients who underwent hematopoietic cell transplantation. The incidence of infection was higher in patients with acute leukemia than with solid tumors (7.8% vs. 4.1%; OR = 2.0; 95% CI = 1.6-2.4; p < 0.0001). The most frequent source of infection was in the urinary tract at 55.2%. More than 57% of K. pneumoniae strains were extended-spectrum β-lactamase-positive and almost 34% were multidrug-resistant. Infections with K. pneumoniae contributed to death in 3.22% of patients. Conclusions: K. pneumoniae is one of the most critical pathogens in children suffering from malignancies or undergoing hematopoietic cell transplantation. The incidence of multidrug-resistant K. pneumoniae strains is increasing and contributing to poor clinical outcome.

Keywords: Klebsiella pneumoniae; acute leukemia; children; hematopoietic cell transplantation; infection.

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Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

**Figure 1**
Cumulative incidence of infections with *K. pneumoniae* in HCT and PHO groups.

**Figure 2**
Susceptibility to antibiotics of *K. pneumoniae* strains isolated from PHO and HCT patients.

**Figure 3**
Infection-free survival from infections with *K. pneumoniae* in HCT and PHO groups.

**Figure 4**
Infection-free survival from infections with *K. pneumoniae* in patients with multiple infections.

See this image and copyright information in PMC

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Infections with Klebsiella pneumoniae in Children Undergoing Anticancer Therapy or Hematopoietic Cell Transplantation: A Multicenter Nationwide Study

Affiliations

Infections with Klebsiella pneumoniae in Children Undergoing Anticancer Therapy or Hematopoietic Cell Transplantation: A Multicenter Nationwide Study

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources