Epidemiology, antimicrobial resistance profile, associated risk factors and management of carbapenem resistant Klebsiella pneumoniae in children under 5 with suspected sepsis in Ethiopia

Background: Early detection and treatment of carbapenem-resistant Klebsiella pneumoniae (CRKP) could reduce the risk of developing life-threatening sepsis in childhood. However, little is known about sepsis caused by CRKP in children under-5 in developing countries. This study aimed to determine the epidemiology, antimicrobial resistance profile, associated risk factors and management of CRKP in children under-5 with sepsis in Ethiopia. Methods: This prospective multicenter study was conducted from June 2021 to December 2023 in three tertiary hospitals in Ethiopia. Samples collection and processing, identification and antimicrobial susceptibility testing were performed according to CLSI guidelines. Sociodemographic data were collected using structured questionnaires. Data were analyzed using STATA-21 and logistic regression to determine associated risk factors. A p-value < 0.05 was considered statistically significant. Results: Among 2483 children under-5 who were suspected of having sepsis, 530 (21.3%) were infected with K. pneumoniae. Infants and newborns were the most vulnerable age categories, with incidences of 25.3% and 34.2%, respectively. About 92.1% and 47.4% of the isolates were confirmed to produce ESBLs and -carbapenemases, respectively. Thus, isolates were resistant to cephalosporins(91–100%), gentamicin(83.7%), meropenem(49.1%), tigecycline(39%), and amikacin(21%). The prevalence rates of MDR, XDR, and PDR strains were 95.7%, 25.9%, and 11.4%, respectively. Combining amikacin with meropenem or tigecycline was used as a treatment option for XDR and PDR strains. Regarding risk factors for sepsis caused by K. pneumoniae included prematurity [AOR = 7.1; 95%CI: 2.3–10.3], prolonged hospitalization [AOR = 4.4;95%CI = 1.9–8.2], admission to the ICU [AOR = 6.2;95% CI:2.8–9.2], pneumonia [AOR = 5.1;95%CI:1.6–13.2], meningitis [AOR = 15.3;95%CI:8.1–29.9], UTI [AOR = 2.1; 95%CI = 1.2–4.2], invasive procedures [AOR = 4.8; 95%CI:1.4–15.5], comorbidities [AOR = 4.2;95%CI = 2.2–13.2], parturition [AOR = 5.4;95%CI:2.5–13.3], and membrane rupture [AOR = 12.1; 95%CI = 2.3–26.2]. Conclusions: The prevalence of bacterial sepsis caused by CRKP in children under 5 is high and became a serious public health concern that requires immediate attention and action.Therefore, it is crucial to revise treatment guidelines and improve IPC practices to reduce children’s morbidity and mortality from those superbugs and beyond.