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Peer-reviewedCC BYAsian biomedicine : research, reviews and news

Risk factors, molecular features, and antibiotic susceptibility in carbapenem-resistant Enterobacterales infections among pediatric patients: a matched case-control study

  • Pintip Suchartlikitwong1
  • Naris Kueakulpattana1
  • Jiratchaya Sophonphan2
  • Tanittha Chatsuwan1
  1. 1Department of Microbiology, Faculty of Medicine , Chulalongkorn University , ,
  2. 2Department of Statistics, the HIV Netherlands Australia Thailand Research Collaboration , ,
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Abstract

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.

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Cite

BibTeXRIS
BibTeX
@article{suchartlikitwong2026risk,
  title = {{Risk factors, molecular features, and antibiotic susceptibility in carbapenem-resistant Enterobacterales infections among pediatric patients: a matched case-control study}},
  author = {Pintip Suchartlikitwong and Naris Kueakulpattana and Jiratchaya Sophonphan and Tanittha Chatsuwan},
  journal = {Asian biomedicine : research, reviews and news},
  year = {2026},
  month = aug,
  doi = {10.2478/abm-2026-0029},
  url = {https://europepmc.org/article/PMC/PMC13718362},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Risk factors, molecular features, and antibiotic susceptibility in carbapenem-resistant Enterobacterales infections among pediatric patients: a matched case-control study
AU  - Pintip Suchartlikitwong
AU  - Naris Kueakulpattana
AU  - Jiratchaya Sophonphan
AU  - Tanittha Chatsuwan
PY  - 2026
DA  - 2026/08/31
JO  - Asian biomedicine : research, reviews and news
DO  - 10.2478/abm-2026-0029
UR  - https://europepmc.org/article/PMC/PMC13718362
AB  - 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.
SN  - 1905-7415
SN  - 1875-855X
ER  -