Clinical infection and molecular characteristics of carbapenem-resistant organisms among children in China, 2016-2025
- 1Lab of Microbiology, Department of Clinical Laboratory, National Children’s Medical Centre, Children’s Hospital of Fudan University, Shanghai, China
- 2Nosocomial Infection Control Department, National Children’s Medical Center, Children’s Hospital of Fudan University, Shanghai, China
- 3Orthopedics Department, National Children’s Medical Centre, Children’s Hospital of Fudan University, Shanghai, People’s Republic of China
Abstract
Background: Carbapenem-resistant organisms (CROs) pose a severe health threat to pediatric patients. We aimed to investigate the epidemiology, clinical infection, and molecular profiles of CROs in Chinese children from 2016 to 2025.
Methods: We retrospectively analyzed 3655 non-duplicate CRO strains isolated from Children’s Hospital of Fudan University between 2016 and 2025, and further selected 499 carbapenem-resistant Enterobacterales (CRE) strains and 315 single or multiple CRO infection cases to investigate the characteristics of different CROs.
Results: The predominant CRO pathogens included carbapenem-resistant A. baumannii (CRAB, 28.5%), K. pneumoniae (CRKP, 27.9%) and P. aeruginosa (CRPAE, 15.6%). CROs were predominantly recovered from the ICU and neonatology departments, with neonates and infants constituting the major population (60.2%). All CROs were highly resistant to most tested antimicrobials, but showed low-resistance to tigecycline (0%–0.8%) and polymyxin B (0.5%–8%). CRKP predominated in blood (36.9%) and urine (44.9%), whereas CRAB was frequently isolated from lower respiratory tract (40.0%) and cerebrospinal fluid (58.3%). The prevalence of CRAB and CRPAE declined gradually between 2016 and 2025, while CRKP experienced a marked resurgence after the COVID-19 pandemic. blaNDM-1 (36.1%), blaNDM-5 (28.5%) and blaKPC-2 (26.9%) were the dominant carbapenemase genes of CREs, with ST11-KPC-KP as the major CRKP subtype. blaKPC-2 were linked to invasive infections (52.9%), whereas blaNDM were associated with noninvasive infections (53.8%~78.8%). In univariate comparisons, multiple CRO infections were associated with older age, elevated WBC and CRP levels, and a higher proportion of blaKPC carriage than single infection. Multivariable logistic regression revealed that prolonged hospitalization, higher WBC and CRP levels were independently associated with multiple CRO infection (all p < 0.05). In contrast, blaKPC and blaNDM carriage were significant risk factors for single CRO infection (both p < 0.01). Additionally, both elevated WBC level and multiple CRO infection were strongly correlated with severe disease (p < 0.05).
Conclusions: blaNDM was the predominant carbapenemase among pediatric CRO strains, yet blaKPC-2 was more prevalent in invasive infections. Multiple CRO infection was independently correlated with severe illness, highlighting the importance of continuous surveillance on multiple CRO infection among children.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12866-026-05519-1.
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BibTeX
@article{li2026clinical,
title = {{Clinical infection and molecular characteristics of carbapenem-resistant organisms among children in China, 2016-2025}},
author = {Huiwen Li and Haodong Zhang and Xiaoying Ye and Pan Fu and Chuanqing Wang},
journal = {BMC Microbiology},
year = {2026},
month = aug,
doi = {10.1186/s12866-026-05519-1},
url = {https://doi.org/10.1186/s12866-026-05519-1},
note = {CC BY-NC-ND 4.0},
}
RIS
TY - JOUR
TI - Clinical infection and molecular characteristics of carbapenem-resistant organisms among children in China, 2016-2025
AU - Huiwen Li
AU - Haodong Zhang
AU - Xiaoying Ye
AU - Pan Fu
AU - Chuanqing Wang
PY - 2026
DA - 2026/08/10
JO - BMC Microbiology
DO - 10.1186/s12866-026-05519-1
UR - https://doi.org/10.1186/s12866-026-05519-1
AB - Background: Carbapenem-resistant organisms (CROs) pose a severe health threat to pediatric patients. We aimed to investigate the epidemiology, clinical infection, and molecular profiles of CROs in Chinese children from 2016 to 2025. Methods: We retrospectively analyzed 3655 non-duplicate CRO strains isolated from Children’s Hospital of Fudan University between 2016 and 2025, and further selected 499 carbapenem-resistant Enterobacterales (CRE) strains and 315 single or multiple CRO infection cases to investigate the characteristics of different CROs. Results: The predominant CRO pathogens included carbapenem-resistant A. baumannii (CRAB, 28.5%), K. pneumoniae (CRKP, 27.9%) and P. aeruginosa (CRPAE, 15.6%). CROs were predominantly recovered from the ICU and neonatology departments, with neonates and infants constituting the major population (60.2%). All CROs were highly resistant to most tested antimicrobials, but showed low-resistance to tigecycline (0%–0.8%) and polymyxin B (0.5%–8%). CRKP predominated in blood (36.9%) and urine (44.9%), whereas CRAB was frequently isolated from lower respiratory tract (40.0%) and cerebrospinal fluid (58.3%). The prevalence of CRAB and CRPAE declined gradually between 2016 and 2025, while CRKP experienced a marked resurgence after the COVID-19 pandemic. blaNDM-1 (36.1%), blaNDM-5 (28.5%) and blaKPC-2 (26.9%) were the dominant carbapenemase genes of CREs, with ST11-KPC-KP as the major CRKP subtype. blaKPC-2 were linked to invasive infections (52.9%), whereas blaNDM were associated with noninvasive infections (53.8%~78.8%). In univariate comparisons, multiple CRO infections were associated with older age, elevated WBC and CRP levels, and a higher proportion of blaKPC carriage than single infection. Multivariable logistic regression revealed that prolonged hospitalization, higher WBC and CRP levels were independently associated with multiple CRO infection (all p < 0.05). In contrast, blaKPC and blaNDM carriage were significant risk factors for single CRO infection (both p < 0.01). Additionally, both elevated WBC level and multiple CRO infection were strongly correlated with severe disease (p < 0.05). Conclusions: blaNDM was the predominant carbapenemase among pediatric CRO strains, yet blaKPC-2 was more prevalent in invasive infections. Multiple CRO infection was independently correlated with severe illness, highlighting the importance of continuous surveillance on multiple CRO infection among children. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s12866-026-05519-1.
SN - 1471-2180
ER -