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BMC Pediatrics

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Open Access 01-12-2023 | Human Immunodeficiency Virus | Research

Association of full blood count findings with risk of mortality in children with Klebsiella pneumoniae bloodstream infection at a south african children’s hospital

Authors: Johanna T Shapaka, Rudzani Muloiwa, Heloise Buys

Published in: BMC Pediatrics | Issue 1/2023

Abstract

Background

Bloodstream infection (BSI) caused by Klebsiella pneumoniae (KP), is a leading cause of hospital-associated childhood mortality. There are limited data on how poor outcomes of KPBSI can be predicted in poorly resourced areas. This study aimed to assess if the profile of differential counts from full blood counts (FBC) taken at two time points in children with KPBSI could be used to predict the risk of death.

Methods

We conducted a retrospective study of a cohort of children admitted to hospital between 2006 and 2011 with KPBSI. FBC collected within 48 h (T1) of blood culture and 5–14 days later (T2), were reviewed. Differential counts were classified as abnormal if they were higher or lower than laboratory ranges for normal results. The risk of death was assessed for each category of differential counts. Risk ratios adjusted (aRR) for potential confounders were used to estimate the effect of cell counts on risk of death using multivariable analysis. Data were stratified by HIV status.

Results

Of 296 children, median age 5 (IQR:2–13) months, 82 were HIV -infected. Ninety-five (32%) children with KPBSI died. Mortality in HIV-infected and uninfected children was 39/82 (48%) and 56/214 (26%), respectively (p < 0.001). Independent associations with mortality were observed with leucopenia, neutropenia and thrombocytopenia. Risk of mortality in HIV-uninfected children with thrombocytopenia at T1 and T2 was aRR 2.5 (95% CI: 1.34–4.64) and 3.18 (95% CI: 1.31–7.73) respectively, whereas the mortality risk in the HIV-infected group with thrombocytopaenia at T1 and T2 was aRR 1.99 (95% CI: 0.94–4.19) and 2.01 (95% CI: 0.65–5.99) respectively. Neutropenia in the HIV-uninfected group at T1 and T2, showed aRR 2.17 (95% CI: 1.22–3.88) and aRR 3.70 (95% CI 1.30-10.51) respectively, while in the HIV-infected group, they were aRR 1.18 (95% CI 0.69–2.03) and aRR 2.05 (95% CI 0.87–4.85) at similar time points. Leucopenia at T2 was associated with mortality in HIV-uninfected and HIV-infected patients, aRR 3.22 (95%CI 1.22–8.51) and aRR 2.34 (95% CI 1.09–5.04) respectively. Persistent high band cell percentage at T2 in HIV-infected children indicated a risk of mortality of aRR 2.91 (95% CI 1.20–7.06).

Conclusion

Abnormal neutrophil counts and thrombocytopenia are independently associated with mortality in children with KPBSI. In resource-limited countries haematological markers have the potential to predict KPBSI mortality.

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Levy I, Leibovici L, Drucker M, Samra Z, Konisberger H, Ashkenazi S. A prospective study of Gram-negative bacteremia in children. Pediatr Infect Dis J. 1996;15(2):117–22. https://journals.lww.com/pidj/fulltext/1996/02000/a_prospective_study_of_gram_negative_bacteremia_in.6.aspx.CrossRefPubMed

de Souza DC, Barreira ER, Faria LS. The epidemiology of sepsis in childhood. Shock. 2017;47(1S):2–5. https://doi.org/10.1097/SHK.0000000000000699.CrossRefPubMed

Rosenthal VD, Al-Abdely HM, El-Kholy AA, AlKhawaja SAA, Leblebicioglu H, Mehta Y, Rai V, Hung NV, Kanj SS, Salama MF. International nosocomial infection Control Consortium report, data summary of 50 countries for 2010–2015: device-associated module. Am J Infect Control. 2016;44(12):1495–504. https://doi.org/10.1016/j.ajic.2016.08.007.CrossRefPubMed

Dellinger PR. The surviving sepsis campaign: 2013 and beyond. In.: LWW; 2013. https://doi.org/10.3760/cma.j.issn.0366-6999.20130920.

Buys H, Muloiwa R, Bamford C, Eley B. Klebsiella pneumoniae bloodstream infections at a south african children’s hospital 2006–2011, a cross-sectional study. BMC Infect Dis. 2016;16(1):1–10. https://doi.org/10.1186/s12879-016-1919-y.CrossRef

Pletz MWN, Welte T. Will polymerase chain reaction (PCR)-based diagnostics improve outcome in septic patients? A clinical view. Intensive Care Med. 2011;37(7):1069–76. https://doi.org/10.1007/s00134-011-2245-x.CrossRefPubMed

Qureshi S. Klebsiella infections. Medscape: Drugs and Diseases http://emedicine medscapecom/article/219907-overview<urlz>i>-a4<spanstyle="background:#66FF66”>2016</span>.</urlz>

Schneider E, Whitmore S, Glynn MK, Dominguez K, Mitsch A, McKenna MT. Revised surveillance case definitions for HIV infection among adults, adolescents, and children aged<18 months and for HIV infection and AIDS among children aged 18 months to <13 years–United States, 2008. Morbidity and Mortality Weekly Report: Recommendations and Reports. 2008;57(10):1–12. www.jstor.org/stable/24842358. Accessed 26 Aug. 2021.PubMed

Sheng W, Wang J, Lu D, Chie W, Chen Y, Chang S. Comparative impact of hospital-acquired infections on medical costs, length of hospital stay and outcome between community hospitals and medical centres. J Hosp Infect. 2005;59(3):205–14. https://doi.org/10.1016/j.jhin.2004.06.003.CrossRefPubMed

10.

World Health Organization: WHO child growth standards and the identification of severe acute malnutrition in infants and children: joint statement by the World Health Organization and the United Nations Children’s Fund. 2009. https://apps.who.int/iris/bitstream/handle/10665/44129/9789?sequence=1.

11.

Orkin SH, Nathan DG, Ginsburg D, Look AT, Fisher DE, Lux S: Nathan and Oski’s Hematology and Oncology of Infancy and Childhood E-Book: Elsevier Health Sciences; 2014

12.

Hui C, Neto G, Tsertsvadze A, Yazdi F, Tricco AC, Tsouros S, Skidmore B, Daniel R. Diagnosis and management of febrile infants (0–3 months). Evidence report/technology assessment 2012(205):1-297. https://europepmc.org/article/nbk/nbk92690#impact

13.

Kyono W, Coates TD. A practical approach to neutrophil disorders. Pediatr Clin. 2002;49(5):929–71. https://doi.org/10.1016/S0031-3955(02)00030-5.CrossRef

14.

Rodeghiero F, Stasi R, Gernsheimer T, Michel M, Provan D, Arnold DM, Bussel JB, Cines DB, Chong BH, Cooper N. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood. 2009;113(11):2386–93. https://doi.org/10.1182/blood-2008-07-162503.CrossRefPubMed

15.

Giles C. The platelet count and mean platelet volume. Br J Haematol. 1981;48(1):31–7. https://doi.org/10.1111/j.1365-2141.1981.00031.x.CrossRefPubMed

16.

Kim SJ, Park GEKJHyun, Lee SL. Chun Soo Kim: clinical features and prognostic factors of early-onset sepsis: a 7.5-year experience in one neonatal intensive care unit. Korean J Pediatr. 2019;62:36–41. https://doi.org/10.3345/kjp.2018.06807.CrossRefPubMed

17.

Rajagopal RTJ, Monagle P. Disseminated intravascular coagulation in paediatrics. Arch Dis Child. 2017;102(2):187–93. https://doi.org/10.1136/archdischild-2016-311053.CrossRefPubMed

18.

Ören IC H, Duman M, Yılmaz S, Irken G. Disseminated intravascular coagulation in pediatric patients: clinical and Laboratory features and prognostic factors influencing the Survival. Pediatr Hematol Oncol. 2005;28(8):679–88. https://doi.org/10.1080/08880010500278749.CrossRef

19.

Ibrahim MK, Zambruni M, Melby CL, Melby PC. Impact of Childhood Malnutrition on host defense and infection. Clin Microbiol Rev. 2017;30(4):919–71. https://doi.org/10.1128/CMR.00119-16.CrossRefPubMedPubMedCentral

20.

Dramowski A, Cotton MF, Rabie H, Whitelaw A. Trends in paediatric bloodstream infections at a south african referral hospital. BMC Pediatr. 2015;15(1):1–11. https://doi.org/10.1186/s12887-015-0354-3.CrossRef

21.

Agnello LGR, Bivona G, Scazzone C, Gambino CM, Iacona A, Ciaccio AM, Lo Sasso B, Ciaccio M. The value of a complete blood Count (CBC) for Sepsis diagnosis and prognosis. Diagnostics (Basel). 2021;12(10). https://doi.org/10.3390/diagnostics11101881. PMID: 34679578; PMCID: PMC8534992.

22.

Moses ANJ, Bagby GC Jr. The influence of human immunodeficiency virus-1 on hematopoiesis. Blood. 1998;91(5). https://doi.org/10.1182/blood.v91.5.1479.

23.

de Stoppelaar SF, Claushuis vtVC, Albersen TA, Roelofs BJ, van der Poll JJ, T T. Thrombocytopenia impairs host defense in gram-negative pneumonia-derived sepsis in mice. Blood. 2014;124(25). https://doi.org/10.1182/blood-2014-05-573915. Epub 2014 Oct 9. PMID: 25301709; PMCID: PMC4263985.

24.

Cotton MF, Violari A, Otwombe K, Panchia R, Dobbels E, Rabie H, Josipovic D, Liberty A, Lazarus E, Innes S. Early limited antiretroviral therapy is superior to deferred therapy in HIV-infected south african infants: results from the CHER (children with HIV Early antiRetroviral) Randomized Trial. Lancet. 2013;382(9904):1555. https://doi.org/10.1016/S0140-6736(13)61409-9.CrossRefPubMedPubMedCentral

Title: Association of full blood count findings with risk of mortality in children with Klebsiella pneumoniae bloodstream infection at a south african children’s hospital
Authors: Johanna T Shapaka
Rudzani Muloiwa
Heloise Buys
Publication date: 01-12-2023
Publisher: BioMed Central
Keywords: Human Immunodeficiency Virus
Neutropenia
Thrombocytopenia
Published in: BMC Pediatrics / Issue 1/2023
Electronic ISSN: 1471-2431
DOI: https://doi.org/10.1186/s12887-023-04104-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Association of full blood count findings with risk of mortality in children with Klebsiella pneumoniae bloodstream infection at a south african children’s hospital

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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