CLINICAL AND LABORATORY FEATURES OF ACUTE INTESTINAL INFECTIONS CAUSED BY KLEBSIELLA PNEUMONIAE IN CHILDREN
Abstract
The aim of the work is to study the clinical and laboratory features of intestinal infections caused by Klebsiella pneumoniae in combination with viruses and other enterobacteria to optimize their diagnosis, prognosis and therapy in young children. Patients and methods. In the department of intestinal Infections of the Children’s Scientific and Clinical Center for Infectious Diseases of the FMBA of Russia in the period 2019–2021, 65 young children who were on inpatient treatment for AII caused by K. pneumoniae were observed. Depending on the etiological forms of the disease, the patients formed 4 groups: K. pneumoniae monoinfection — group “Kp” (n=29); combination of K. pneumoniae with intestinal viruses — group “Kp+V” (n=14); combination of K. pneumoniae with opportunistic enterobacteria (OEB) — group “Kp+OB” (n=14); combination of K. pneumoniae with intestinal viruses and OEB — group “Kp+V+OEB” (n=8). Clinical and laboratory data were evaluated in all children. The degree of intestinal dysbiosis, in addition to the generally accepted criteria, was characterized by the content of atypical E. coli in feces (lg CFU/g). Etiological diagnosis of AII was performed using the bacteriological method and polymerase chain reaction. During statistical processing, the average values of indicators, the average frequency of deviations of indicators from the norm (M±σ; P±σ) were determined, differences in groups were revealed using the t-test and Pearson’s criterion χ2; they were considered reliable at p <0.05. Methods of variance and discriminant analysis were used. Results. The higher age of children in the groups “Kp+V” and “Kp+V+OEB” was revealed. The association of K. pneumoniae with viruses in these groups was accompanied by an increase in the frequency of diarrhea (p <0.05). The frequency of thrombocytosis and monocytosis differed in the groups of children (p <0.05) and was maximal in the groups “Kp+OEB” and “Kp+V”, respectively. The content of atypical E. coli in faeces in the “Kp” group was lower than in the “Kp+OEB” group (p<0.05). The duration of inpatient treatment was longer in the “Kp” and “Kp+V+OEB” groups. The discriminant model included the following signs: age of children (p=0.0015); complaints of lethargy (p=0.02); complaints of vomiting (p=0.08); platelet count in the hemogram (p=0.006); amylorrhea in the coprogram (p=0.0008); stool pH (p=0.12); duration inpatient treatment (p=0.004); combination of K. pneumoniae with OEB (p<0.00001). The overall diagnostic signifi cance of the model was 89.2%. Conclusion. Using discriminant analysis, it was found that the features of clinical and laboratory signs of acute intestinal infections caused by K. pneumoniae in young children are more determined by the combination of K. pneumoniae with opportunistic enterobacteria than by the combination with viruses.
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