A Decade Long Retrospective Cohort Study on Risk Factors and Clinical Outcomes of Carbapenem Resistant Gram-Negative Infections in A Pediatric Intensive Care Unit

BackgroundCarbapenem-resistant Gram-negative (CRGN) infections are a critical global health threat, particularly in pediatric intensive care units (PICUs). This study aimed to identify independent risk factors and clinical outcomes associated with CRGN infections in critically ill children.MethodsA 10-year (2015-2024) retrospective cohort study was conducted in a tertiary PICU, including 380 patients (aged 1 month-18 years) with Gram-negative infections. Patients were stratified into CRGN (n = 106) and carbapenem-susceptible (CSGN, n = 274) groups. Primary outcomes were independent risk factors for CRGN and 30-day all-cause mortality.ResultsThe overall CRGN prevalence was 27.9% (106/380), with an estimated absolute increase of 1.10 percentage points per year; however, the temporal trend was not statistically significant (p = .204). Predominant pathogens were Klebsiella spp. (31.1%) and E. coli (24.1%). Multivariate analysis identified polymicrobial infection (OR = 6.981, p < .001), mechanical ventilation (OR = 2.124, p = .025), systemic corticosteroid use (OR = 2.072, p = .012), underlying comorbidities (OR = 1.873, p = .022), and central venous catheters (OR = 1.906, p = .030) as independent risk factors for CRGN infection. The 30-day mortality was significantly higher in the CRGN group (27.4% vs 8.8%, p < .001). CRGN infection was the strongest independent predictor of mortality (OR = 2.49, p = .043), alongside PRISM III score and multiple comorbidities. The rate of appropriate empirical therapy was critically low in the CRGN group (36.8% vs 73.4%, p < .001).ConclusionsCRGN infections in the PICU are driven by invasive procedures and immunosuppression, associated with 2.48-fold higher odds of mortality. Early identification, tailored antimicrobial stewardship, and optimization of empirical therapy are urgently required to improve survival.