# Prevalence of carbapenem-resistant Enterobacterales colonisation in hospitalised neonates

## TL;DR

This study found that nearly a quarter of preterm neonates transferred between hospitals in South Africa were colonized with dangerous antibiotic-resistant bacteria, but this colonization did not lead to infections or higher mortality.

## Contribution

The study reports high CRE colonization prevalence in neonates during hospital transfers without identifying risk factors or clinical consequences.

## Key findings

- 22.3% of 291 neonates were colonized with carbapenem-resistant Enterobacterales at hospital transfer.
- Klebsiella pneumoniae was the most common colonizing species (90.8% of cases).
- CRE colonization was not associated with increased infection risk or mortality in neonates.

## Abstract

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

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).

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

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 Klebsiella pneumoniae (59/65, 90.8%) and Serratia marcescens (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%]; p = 0.737).

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

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.