Risk factors, molecular features, and antibiotic susceptibility in carbapenem-resistant Enterobacterales infections among pediatric patients: a matched case-control study
Pintip Suchartlikitwong, Naris Kueakulpattana, Jiratchaya Sophonphan, Tanittha ChatsuwanAbstract
Background
Carbapenem-resistant Enterobacterales (CRE) infections are a growing global concern, with limited data in children.
Objectives
This study aimed to identify risk factors for pediatric CRE infections and characterize their resistance genes and antibiotic susceptibility.
Methods
From January 2020 to March 2024, pediatric patients diagnosed with CRE infections >48 h after admission at a tertiary-care hospital in Bangkok were consecutively enrolled. A matched case-control study was conducted, pairing each CRE case 1:1 with a carbapenem-susceptible Enterobacterales (CSE) control based on infection site and age. Risk factors were analyzed using conditional logistic regression. Carbapenemase genes were detected using multiplex polymerase chain reaction, and antibiotic susceptibilities were determined by minimal inhibitory concentration testing.
Results
Seventy-six CRE cases and 76 matched CSE controls were included. Urinary tract infections were most common (42.1%). Independent risk factors included referral from other hospitals (adjusted odds ratios [aOR] 4.32; 95% CI 1.57–11.96), prior exposure to carbapenems (aOR 7.24; 95% CI 1.06–25.42), and third-generation cephalosporins (aOR 3.68; 95% CI 1.32–10.25). Klebsiella pneumoniae (72.4%) predominated among CRE isolates; Escherichia coli (52.6%) among CSE. Carbapenemase genes were detected in 76.3% of CRE isolates, mainly bla NDM (60.3%) and bla OXA-48 (51.7%). Among non-carbapenems, amikacin showed the highest susceptibility against CSE (98.7%), and colistin against CRE isolates (88.2%). Ceftazidime/avibactam susceptibility was 100% among non-carbapenemase-producing CRE and 63.3% among CRE isolates with bla OXA-48 .
Conclusions
Pediatric CRE infections are associated with healthcare exposures and prior broad-spectrum antibiotic use. The high prevalence of carbapenemase genes and reduced antibiotic susceptibility emphasize the need for enhanced surveillance and targeted therapies.