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Carbapenem-resistant Enterobacterales colonisation in a tertiary PICU, Cape Town, South Africa
Elri du Plooy1, Angela Dramowski1, Pieter Nel2,3
1Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Insights
Carbapenem-resistant Enterobacterales (CRE) colonization is common in South African pediatric intensive care units (PICUs). Younger children were more likely to be colonized upon admission and acquire CRE during their stay.
Area of Science:
- Infectious Diseases
- Public Health
- Pediatrics
Background:
- Carbapenem-resistant Enterobacterales (CRE) pose a significant threat in healthcare settings, particularly in resource-limited pediatric intensive care units (PICUs).
- The prevalence and clinical predictors of CRE colonization in South African PICUs remain largely unknown, necessitating urgent investigation.
Purpose of the Study:
- To determine the prevalence of CRE colonization among children admitted to a South African PICU.
- To identify potential clinical predictors associated with CRE colonization in this vulnerable population.
Main Methods:
- A prospective study was conducted from January to December 2022 at Tygerberg Hospital PICU, Cape Town.
- Rectal swabs were collected from admitted children to assess for prevalent (on admission) and incident (acquired during PICU stay) CRE colonization.
- Clinical data, including age and length of stay, were analyzed in relation to CRE status.
Main Results:
- Of 552 children included, 8% (44/552) were colonized with CRE on admission, and 10.6% (24/227) acquired CRE during their PICU stay.
- Children with prevalent CRE colonization were younger (median 4.5 months) than those without.
- Children with incident CRE colonization were also younger (median 3 months) and had longer PICU stays (median 7 days).
Conclusions:
- CRE colonization is a common occurrence in this South African PICU, impacting patient management and infection control strategies.
- Younger age is a significant predictor for both prevalent and incident CRE colonization.
- Further research into clinical predictors is crucial for developing effective screening and intervention protocols to combat CRE spread.
Background:
Carbapenem-resistant Enterobacterales (CRE) are important healthcare-associated pathogens in resource-limited paediatric intensive care units (PICUs). The prevalence and clinical predictors of CRE colonisation in South African PICUs are unknown.
Objectives:
To determine CRE colonisation status in a South African PICU.
Method:
Between 01 January 2022 and 31 December 2022, we collected admission and exit rectal swabs from children admitted to Tygerberg Hospital PICU, Cape Town. Prevalent CRE was defined as CRE-colonised at PICU admission, including children isolating CRE in the preceding 6 months. Incident CRE was defined as acquisition of CRE colonisation during the PICU stay.
Results:
Among 638 PICU admissions, we included 552 children (median age 9 months, 54% male) with an entry swab and/or known positive CRE colonisation status; 237 (42.9%) had exit rectal swabs collected. Prevalent CRE was identified in 8% (44/552) on admission, with 29/44 (65.9%) newly identified as CRE-colonised. Incident CRE was identified in 24/227 (10.6%) admissions. Children with prevalent CRE were younger than those not CRE-colonised at PICU entry (median 4.5 months vs 10 months; p < 0.05). Children with incident CRE were younger (median 3 months vs 8 months; p < 0.05), and had longer PICU stays (median 7 vs 4 days; p < 0.05) compared to those who remained CRE-non-colonised.
Conclusion:
CRE colonisation is common in PICU patients with implications for admission, isolation and antibiotic policies. Better understanding of clinical predictors of CRE colonisation will support the development of appropriate CRE screening recommendations and interventions.
Contribution:
This study provides insight into the burden and predictors of CRE colonisation in a South African PICU setting.
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