du Plooy Elri, Dramowski Angela, Nel Pieter, Parker Noor M, Rabie Helena
Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
Division of Medical Microbiology, Department of Pathology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
S Afr J Infect Dis. 2025 Jun 11;40(1):720. doi: 10.4102/sajid.v40i1.720. eCollection 2025.
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.
To determine CRE colonisation status in a South African PICU.
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.
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; < 0.05). Children with incident CRE were younger (median 3 months vs 8 months; < 0.05), and had longer PICU stays (median 7 vs 4 days; < 0.05) compared to those who remained CRE-non-colonised.
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.
This study provides insight into the burden and predictors of CRE colonisation in a South African PICU setting.
耐碳青霉烯类肠杆菌科细菌（CRE）是资源有限的儿科重症监护病房（PICU）中重要的医疗保健相关病原体。南非PICU中CRE定植的患病率和临床预测因素尚不清楚。
确定南非一家PICU中CRE的定植状况。
在2022年1月1日至2022年12月31日期间，我们收集了开普敦泰格堡医院PICU收治儿童的入院和出院时直肠拭子。流行的CRE定义为PICU入院时CRE定植，包括在过去6个月内分离出CRE的儿童。新发CRE定义为在PICU住院期间获得CRE定植。
在638例PICU入院病例中，我们纳入了552名儿童（中位年龄9个月，54%为男性），他们有入院拭子和/或已知的CRE阳性定植状态；237例（42.9%）收集了出院时直肠拭子。入院时8%（44/552）被确定为流行的CRE，其中29/44（65.9%）为新发现的CRE定植。在24/227例（10.6%）入院病例中发现了新发CRE。流行CRE的儿童比PICU入院时未被CRE定植的儿童年龄更小（中位年龄4.5个月对10个月；P<0.05）。与仍未被CRE定植的儿童相比，新发CRE的儿童年龄更小（中位年龄3个月对8个月；P<0.05），且PICU住院时间更长（中位7天对4天；P<0.05）。
CRE定植在PICU患者中很常见，对入院、隔离和抗生素政策有影响。更好地了解CRE定植的临床预测因素将有助于制定适当的CRE筛查建议和干预措施。
本研究深入了解了南非PICU环境中CRE定植的负担和预测因素。
