# Carbapenem-resistant Enterobacterales colonisation in a tertiary PICU, Cape Town, South Africa

## TL;DR

This study examines how common CRE infections are in a South African pediatric intensive care unit and identifies factors that increase the risk of these infections.

## Contribution

The study is the first to report CRE colonization rates and clinical predictors in a South African PICU.

## Key findings

- CRE colonization was found in 8% of children upon admission to the PICU.
- Younger age and longer PICU stays were linked to higher CRE colonization rates.
- 10.6% of children acquired CRE during their PICU stay.

## Abstract

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; 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.

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.