Carbapenemase-Producing Carbapenem-Resistant Enterobacterales Among Children in the United States, 2019-2024

BACKGROUND: The current epidemiology of carbapenem-resistant Enterobacterales (CRE) among pediatric patients in the United States is poorly described. We assessed trends in pediatric CRE and carbapenemase-producing-CRE (CP-CRE) incidence in the U.S. and characterized recent pediatric CP-CRE cases. METHODS: We analyzed CRE clinical isolates from patients <18 years submitted to CDC's Antimicrobial Resistance Laboratory Network from January 2019 through December 2024. Annual unadjusted incidence rates for CRE and CP-CRE were estimated overall and by age group for a national convenience sample and an open cohort of 29 states with required CRE isolate submission. Trends were assessed using Poisson regression. For pediatric patients with incident CP-CRE identified from January 2023 through March 2024, medical chart reviews were performed. RESULTS: From 2019-2024, the estimated national pediatric CRE and CP-CRE incidence increased 51% (IRR:1.51; 95% CI:1.22, 1.88) and 92% (IRR:1.92; 95% CI:1.25, 2.99), respectively; increases were similar in the open cohort. Infants had the highest incidence rates. Overall, NDM-CRE incidence increased (IRR: 4.24; 95% CI: 2.07, 9.16), surpassing KPC-CRE as the most prominent carbapenemase. Chart reviews were completed for 109 of 129 pediatric patients with CP-CRE; 14% were in patients without healthcare risk factors. Among patients with healthcare risk factors, 75% had an underlying medical condition; the most common underlying condition among infants and toddlers was cardiovascular disease (64%) and among older children was neurocognitive conditions (49%) and malignancies (41%). Common exposures across all age groups included intensive care unit hospitalization (40%) and healthcare outside the United States (37%). CONCLUSIONS: Pediatric CP-CRE incidence is increasing, driven by NDM-CRE for which there are few treatment options. Most cases occurred among children with serious underlying conditions receiving high-acuity care. Prevention opportunities may include admission screening for patients with prior healthcare exposure outside the United States and strengthening infection prevention practices.

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Journal
Journal of the Pediatric Infectious Diseases Society
Published
2026-11-04
DOI
https://doi.org/10.1093/jpids/piag115
Primary Topic
Antibiotic Resistance in Bacteria
Type
article
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article

Carbapenemase-Producing Carbapenem-Resistant Enterobacterales Among Children in the United States, 2019-2024

Sarah Sabour, Christopher Prestel, Patricia Kopp, James M. Baggs et al.
Journal of the Pediatric Infectious Diseases Society
Antibiotic Resistance in Bacteria
article

Carbapenemase-Producing Carbapenem-Resistant Enterobacterales Among Children in the United States, 2019-2024

Sarah Sabour, Christopher Prestel, Patricia Kopp, James M. Baggs, Danielle A. Rankin, Muhammad Salman Ashraf, Kaitlyn Chorbi, Sarah J. Kogut, Jessica Leaf, Laxmi Modali, Jennifer Y. Huang, Marisa D’Angeli, Katherine Draper, Lauren Pasutti, Belinda E. Ostrowsky, Brooklyn White, Mefruz Salwa Haque, Anna L. Stahl, Elizabeth J. Nazarian, Jennifer Driscoll, Cherlly Bailey, Dominique Balan, Brady Ryan, Maroya Spalding Walters, Sandeep K. Bhaurla, Nicole M. Green, Candace L. Johnson, Elisabeth Vaeth, Tisha Mitsunaga, Shamta S. Warang, Adrienne Sherman, Jehan Mephors, Mohsin Ali, Lorene Fong, Michelle Gardner, Emily Lucrezia, Lian Hsiao, Mohammed A. Khan, Mike Tran, Andrea Kaplan, Karen J Williams, Grace Lee, Ishrat Kamal Ahmed, Bea Jensen, Tiana Armstrong, Bethany Lynn Lavender, Zakariya Mahmod, Kajal Amin, Kourtney Lopez, Lauren Young, Pediatric CRE Investigation Group, Tahani Hamdan, Valerie Jividen, Elizabeth R Hofmann, Sarah Hanson, Ann-Catherine Stanton, Nicole Burton, Erin Johnson
article en

Abstract

BACKGROUND: The current epidemiology of carbapenem-resistant Enterobacterales (CRE) among pediatric patients in the United States is poorly described. We assessed trends in pediatric CRE and carbapenemase-producing-CRE (CP-CRE) incidence in the U.S. and characterized recent pediatric CP-CRE cases. METHODS: We analyzed CRE clinical isolates from patients <18 years submitted to CDC's Antimicrobial Resistance Laboratory Network from January 2019 through December 2024. Annual unadjusted incidence rates for CRE and CP-CRE were estimated overall and by age group for a national convenience sample and an open cohort of 29 states with required CRE isolate submission. Trends were assessed using Poisson regression. For pediatric patients with incident CP-CRE identified from January 2023 through March 2024, medical chart reviews were performed. RESULTS: From 2019-2024, the estimated national pediatric CRE and CP-CRE incidence increased 51% (IRR:1.51; 95% CI:1.22, 1.88) and 92% (IRR:1.92; 95% CI:1.25, 2.99), respectively; increases were similar in the open cohort. Infants had the highest incidence rates. Overall, NDM-CRE incidence increased (IRR: 4.24; 95% CI: 2.07, 9.16), surpassing KPC-CRE as the most prominent carbapenemase. Chart reviews were completed for 109 of 129 pediatric patients with CP-CRE; 14% were in patients without healthcare risk factors. Among patients with healthcare risk factors, 75% had an underlying medical condition; the most common underlying condition among infants and toddlers was cardiovascular disease (64%) and among older children was neurocognitive conditions (49%) and malignancies (41%). Common exposures across all age groups included intensive care unit hospitalization (40%) and healthcare outside the United States (37%). CONCLUSIONS: Pediatric CP-CRE incidence is increasing, driven by NDM-CRE for which there are few treatment options. Most cases occurred among children with serious underlying conditions receiving high-acuity care. Prevention opportunities may include admission screening for patients with prior healthcare exposure outside the United States and strengthening infection prevention practices.

Journal of the Pediatric Infectious Diseases Society
Centers for Disease Control and Prevention (US), New York State Department of Health (US), California Department of Public Health (US), Massachusetts Department of Public Health (US), Texas Department of State Health Services (US), United States Public Health Service (US), District of Columbia Department of Health (US), National Center for Emerging and Zoonotic Infectious Diseases (US), Tennessee Department of Health (US), Houston Health and Human Services Department (US)
Openalex Percentile: Top 24%
Antibiotic Resistance in Bacteria
DOISourceOpenAlex
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