Prevalence of carbapenem-resistant Enterobacterales colonisation in hospitalised neonates.

BACKGROUND

Carbapenem-resistant Enterobacterales (CRE) have emerged as major healthcare-associated infection (HAI) pathogens globally with substantial associated mortality and morbidity.

OBJECTIVES

We conducted a retrospective cohort study to determine the prevalence of rectal CRE colonisation in neonates referred from a central hospital, to a regional and a district hospital in the Western Cape Province of South Africa (01 March 2019 - 30 September 2020).

METHOD

Clinical data and laboratory records were reviewed to identify possible factors associated with CRE colonisation using stepwise forward logistic regression analysis.

RESULTS

Among 291 neonates transferred to the regional and district hospitals, the median birth weight and gestational age were 1360 (interquartile range [IQR]: 1080 g - 1690 g) and 31 (IQR: 29-33) weeks. The overall CRE rectal colonisation prevalence at the time of transfer from the central hospital was 22.3% (65/291), with colonising species including (59/65, 90.8%) and (6/65; 9.2%). There were no factors significantly associated with CRE colonisation. No CRE-colonised neonate subsequently developed CRE infection. Post-discharge mortality rates were similar in the CRE-colonised versus the non-colonised neonates (2/65 [3.1%] vs. 9/226 [4.0%]; = 0.737).

CONCLUSION

There was no increased risk of subsequent CRE infection or mortality in the 12 months post-discharge in neonates who were CRE colonised.

CONTRIBUTION

Rectal colonisation with CRE was highly prevalent in preterm neonates being transferred for step-down hospital care. Carbapenem-resistant Enterobacterales-colonised neonates had similar demographic characteristics to non-colonised neonates, with no factors significantly associated with CRE colonisation.