Carbapenemase-Producing Carbapenem-Resistant Enterobacterales Among Children in the United States, 2019-2024
Danielle A Rankin, Anna L Stahl, Mohsin Ali, Christopher Prestel, Mohammed A Khan, Sarah Kogut, Elizabeth Nazarian, Kajal Amin, Kourtney Lopez, Brady Ryan, Lian Hsiao, Tisha Mitsunaga, Mefruz S Haque, Candace Johnson, Jessica Leaf, Cherlly Bailey, Lauren Young, Tahani Hamdan, Zakariya Mahmod, Belinda Ostrowsky, Tiana Armstrong, Sarah Sabour, Jennifer Y Huang, James Baggs, Maroya Spalding Walters, , Ishrat Kamal Ahmed, Muhammad Salman Ashraf, Dominique Balan, Sandeep Bhaurla, Nicole Burton, Kaitlyn Chorbi, Marisa D'Angeli, Katherine Draper, Jennifer Driscoll, Lorene Fong, Michelle Gardner, Nicole M Green, Sarah Hanson, Elizabeth R Hofmann, Bea Jensen, Valerie Jividen, Erin Johnson, Andrea Kaplan, Patricia Kopp, Bethany Lynn Lavender, Grace Lee, Emily Lucrezia, Jehan Mephors, Laxmi Modali, Lauren Pasutti, Adrienne Sherman, Ann-Catherine Stanton, Mike Tran, Elisabeth Vaeth, Shamta S Warang, Brooklyn White, Karen J WilliamsABSTRACT
Background
The current epidemiology of carbapenem-resistant Enterobacterales (CRE) among pediatric patients in the United States is poorly described. We assessed trends in pediatric CRE and carbapenemase-producing-CRE (CP-CRE) incidence in the U.S. and characterized recent pediatric CP-CRE cases.
Methods
We analyzed CRE clinical isolates from patients <18 years submitted to CDC’s Antimicrobial Resistance Laboratory Network from January 2019 through December 2024. Annual unadjusted incidence rates for CRE and CP-CRE were estimated overall and by age group for a national convenience sample and an open cohort of 29 states with required CRE isolate submission. Trends were assessed using Poisson regression. For pediatric patients with incident CP-CRE identified from January 2023 through March 2024, medical chart reviews were performed.
Results
From 2019–2024, the estimated national pediatric CRE and CP-CRE incidence increased 51% (IRR:1.51; 95% CI:1.22, 1.88) and 92% (IRR:1.92; 95% CI:1.25, 2.99), respectively; increases were similar in the open cohort. Infants had the highest incidence rates. Overall, NDM-CRE incidence increased (IRR: 4.24; 95% CI: 2.07, 9.16), surpassing KPC-CRE as the most prominent carbapenemase. Chart reviews were completed for 109 of 129 pediatric patients with CP-CRE; 14% were in patients without healthcare risk factors. Among patients with healthcare risk factors, 75% had an underlying medical condition; the most common underlying condition among infants and toddlers was cardiovascular disease (64%) and among older children was neurocognitive conditions (49%) and malignancies (41%). Common exposures across all age groups included intensive care unit hospitalization (40%) and healthcare outside the United States (37%).
Conclusions
Pediatric CP-CRE incidence is increasing, driven by NDM-CRE for which there are few treatment options. Most cases occurred among children with serious underlying conditions receiving high-acuity care. Prevention opportunities may include admission screening for patients with prior healthcare exposure outside the United States and strengthening infection prevention practices.