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

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ID: 338648
2026
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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.
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Authors Danielle A. Rankin, Anna L. Stahl, Mohsin Ali, Christopher Prestel, Mohammed A. Khan, Sarah J. Kogut, Elizabeth J. Nazarian, Kajal Amin, Kourtney Lopez, Brady Ryan, Lian Hsiao, Tisha Mitsunaga, Mefruz Salwa Haque, Candace L. Johnson, Jessica Leaf, Cherlly Bailey, Lauren Young, Tahani Hamdan, Zakariya Mahmod, Belinda E. Ostrowsky, Tiana Armstrong, Sarah Sabour, Jennifer Y. Huang, James M. Baggs, Maroya Spalding Walters, Pediatric Cre Investigation Group, Ishrat Kamal Ahmed, Muhammad Salman Ashraf, Dominique Balan, Sandeep K. Bhaurla, Nicole Burton, Kaitlyn Chorbi, Marisa D'Angeli, Katherine Draper, Jennifer Driscoll, Lorene Fong, Michelle Gardner, Nicole M. Green, Sarah Hanson, Elizabeth R Hofmann, Bea Jensen, Valerie Jividen, Erin Johnson, Andrea Kaplan, Patricia Kopp, Bethany Lynn Lavender, Grace Lee, Emily Lucrezia, Jehan Mephors, Laxmi Modali, Lauren Pasutti, Adrienne Sherman, Ann-Catherine Stanton, Mike Tran, Elisabeth Vaeth, Shamta S. Warang, Brooklyn White, Karen J Williams
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Journal journal of the pediatric infectious diseases society
Year 2026
DOI
10.1093/jpids/piag115
URL
https://doi.org/10.1093/jpids/piag115
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