Carbapenem-Resistant Enterobacteriaceae Infection in Immunocompromised Children with CRE Colonization: Incidence and Outcomes in an Antibiotic-Limited Setting

Abstract

Objective: To determine the incidence of carbapenem-resistant Enterobacteriaceae (CRE) infection in patients with CRE colonization and compare the treatment outcomes between febrile patients with non-septic presentation who received empirical treatment with meropenem and those who did not. Material and Methods: The medical records of febrile patients with CRE colonization aged <15 years who were hospitalized at Songklanagarind Hospital between January 2018 and December 2020 were reviewed. Results: Among the 61 patients with CRE colonization, CRE infection was identified during eight febrile episodes in six patients (9.8%). Hematologic malignancies, solid tumors, and other diseases were diagnosed in 21 (34.4%), 25 (41.0%), and 15 (24.6%) patients, respectively. The median (interquartile range [IQR]) duration from CRE colonization to the first episode of fever was 22 (1.8–60.8) days. Among the 82 febrile episodes without initial sepsis or central nervous system infection, 19 and 63 episodes, respectively, were initially treated with meropenem and non-carbapenems. Treatment outcomes—including the proportion of patients needing step-up antibiotics (21.1% vs. 36.5%), development of sepsis (5.3% vs. 15.9%), and death within 30 days (6.6% vs. 9.8%) - were not significantly different between the two groups.Patients who developed sepsis had significantly higher resistance to empirical antibiotics (75% vs. 26.3%) as well as a significantly higher incidence of severe neutropenia lasting more than one week (85.7% vs. 21.9%) than those without sepsis.Conclusion: Patients with CRE colonization who exhibit fever without clinical sepsis and have an absolute neutrophil count >100 cells/mm3 can be empirically treated with non-carbapenems.