Invasive carbapenem-resistant Enterobacteriaceae infection at a paediatric hospital: A case series.
BACKGROUND
There are no paediatric reports of invasive infection caused by carbapenem-resistant Enterobacteriaceae (CRE) from Africa.


OBJECTIVE
To document a series of cases of CRE infections at a tertiary children's hospital in Cape Town, South Africa, describing the clinical and microbiological findings in these children.


METHODS
A retrospective, descriptive study was completed using data from a series of children with invasive CRE infection between 2010 and 2015, sourced from their clinical notes and microbiology results.


RESULTS
The first of 10 invasive CRE infections during the study period occurred in November 2012. Nine CRE infections were caused by Klebsiella pneumoniae, and one by both K. pneumoniae and Escherichia coli. The median age was 25 months (interquartile range (IQR) 5 - 60). All 10 CRE infections were hospital acquired. The median length of hospitalisation before CRE infection was 28.5 days (IQR 20 - 44). Eight of the children were exposed to carbapenems during the 12-month period prior to invasive CRE infection. Six were treated with colistin and carbapenem combination therapy, of whom 2 died, including 1 of a non-CRE event. The other 4 children received colistin monotherapy. All these children died, including 2 from non-CRE events.


CONCLUSIONS
Children with invasive CRE infection and severe underlying disease must be treated with combination antibiotic therapy. Strict infection control practice and antibiotic stewardship are necessary to contain the spread of CRE and limit the number of new infections.
Paediatric Infectious Diseases Unit, Red Cross War Memorial Children's Hospital, Cape Town, and Department of Paediatrics and Child Health, University of Cape Town, South Africa. ombevaom@gmail.com.
Oliver Ombeva
OO
Malande
Annerie
A
Du Plessis
Diane
D
Rip
Colleen
C
Bamford
Brian
B
Eley
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D015780:Carbapenems / Q000627:therapeutic use*; D002675:Child, Preschool; D003428:Cross Infection / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D004756:Enterobacteriaceae Infections / Q000188:drug therapy / Q000382:microbiology / Q000401:mortality / Q000503:physiopathology; D004926:Escherichia coli / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D017053:Infection Control / Q000379:methods / Q000592:standards; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D008297:Male; D008826:Microbial Sensitivity Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013019:South Africa / Q000453:epidemiology; D016019:Survival Analysis; D018440:beta-Lactam Resistance
D000900:Anti-Bacterial Agents; D015780:Carbapenems