Gastrointestinal carriage of carbapenemase-producing enterobacterales among inpatient and outpatient children in Kenya

Gastrointestinal carriage of antimicrobial-resistant bacteria, especially carbapenemase-producing Enterobacterales (CPE), presents a critical public health threat globally. However, in many resource-constrained countries, epidemiological data on CPE is limited. Here, we assessed gastrointestinal carriage and associated factors of CPE among inpatient and outpatient children (≤ 5 years). This hospital-based cross-sectional study was conducted at Thika Level 5 Hospital in Kenya from February to June 2023. In total, 540 participants were recruited from outpatient (270) and inpatient (270) children, excluding those admitted for < 48 h and outpatients with ≤ 3 months hospitalization history. Demographic data were collected using a questionnaire, and stool or swab samples were cultured following standard microbiology methods. Automated platforms were used for isolates identification and antimicrobial susceptibility testing. Gastrointestinal carriage rate of CPE was 9.6%, 95% confidence interval (CI): 6.39-13.79% (26/270) among the inpatients and 5.9%, 95% CI: 3.42-9.45% (16/270) among the outpatients. The carbapenemase-producing Enterobacterales were predominated by multidrug-resistant Escherichia coli from inpatients (22/22, 100%) and outpatients (8/10, 80%). The colonization rate was higher among inpatients who were presenting with chills (aOR = 10.57, p = 0.008). We report a high gastrointestinal carriage of CPE among children (≤ 5 years). Strict adherence to colonization screening, and antimicrobial stewardship policies are critical to control CPE dissemination in the current study area and beyond.