Abstract
BACKGROUND AND AIMS: Carbapenem-resistant Enterobacterales (CRE) colonization is an important prerequisite to hospital-acquired infections (HAIs) caused by CRE and increased mortality. This study assessed the prevalence of, and risk factors for, CRE colonization among children admitted to a provincial pediatric hospital in a high-antimicrobial-resistance setting in Vietnam. METHODS: A point prevalence survey was conducted on 15 August 2022 at a provincial pediatric hospital in the Red River Delta. Rectal swabs were collected from 376 hospitalized children after informed consent. Samples were inoculated on chromogenic selective agar for CRE detection, and bacterial identification and antimicrobial susceptibility testing were performed using the VITEK(®) 2 system. Clinical and demographic data were obtained from structured questionnaires and medical records. Logistic regression analyses were used to identify risk factors associated with CRE colonization. RESULTS: CRE colonization was detected in 28.2% of hospitalized children. Colonization was more common among patients screened >48 hours after admission (30.8%) and hospitalization >48 hours was associated with a 2.27-fold increased risk of colonization (p = 0.026) compared with screening earlier. Prevalence increased with length of stay, reaching 40.8% among those hospitalized ≥7 days. Children ≤6 years had a colonization rate of 29.7%. The highest ward-level prevalence occurred in the Intensive Care Unit (77.8%), whereas the lowest rates were observed in trauma and nutrition wards (9.5%). Escherichia coli (40.6%), Klebsiella pneumoniae (34.4%), and Enterobacter cloacae (16.4%) were the predominant CRE species. Most isolates were resistant to 4-10 antimicrobial classes. CRE colonization was also significantly associated with sepsis at the time of assessment. CONCLUSIONS: CRE colonization was highly prevalent among pediatric inpatients in this provincial Vietnamese hospital, particularly among young children, those hospitalized for prolonged periods, and patients in intensive care or neonatal units. These findings underscore the urgent need to strengthen infection prevention and control (IPC) strategies and to implement targeted screening approaches to assess the effect on CRE transmission of improvement of IPC.