Abstract
BACKGROUND: Carbapenem-resistant Enterobacterales (CRE) have emerged as major healthcare-associated infection (HAI) pathogens globally with substantial associated mortality and morbidity. OBJECTIVES: 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). METHOD: Clinical data and laboratory records were reviewed to identify possible factors associated with CRE colonisation using stepwise forward logistic regression analysis. RESULTS: 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). CONCLUSION: There was no increased risk of subsequent CRE infection or mortality in the 12 months post-discharge in neonates who were CRE colonised. CONTRIBUTION: 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.