A Centers for Disease Control and Prevention surveillance study found carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) infections among U.S. children climbed 92% from 2019 to 2024. Published in the Journal of the Pediatric Infectious Diseases Society on November 4, the analysis shows overall pediatric CRE incidence rose 51%. Infants experienced the highest infection rates.
Researchers examined clinical isolates submitted from patients under 18 to the CDC Antimicrobial Resistance Laboratory Network across a national sample and a 29-state mandatory-reporting cohort. Over the five-year period, New Delhi metallo-beta-lactamase (NDM) CRE incidence more than quadrupled, posting an incidence rate ratio of 4.24. NDM overtook KPC as the leading carbapenemase type in children. NDM enzymes resist avibactam, vaborbactam, and relebactam; aztreonam-avibactam is currently approved only for adults aged 18 and older.
Investigators reviewed medical charts for 109 of 129 children diagnosed with incident CP-CRE between January 2023 and March 2024. Only 14% lacked healthcare risk factors, while 75% of at-risk patients had serious underlying illnesses. Cardiovascular disease led among infants and toddlers at 64%, whereas neurocognitive conditions (49%) and cancers (41%) predominated among older children. Across all age groups, the most common exposures were intensive care unit hospitalization (40%) and healthcare received outside the United States (37%).
CDC previously estimated roughly 12,700 U.S. CRE infections and 1,100 deaths in 2020 and warned that NDM-CRE growth threatens higher totals. Study authors urged hospitals to implement admission screening for pediatric patients with prior healthcare exposure abroad and expand rapid carbapenemase testing. CDC officials flagged that limited clinical laboratory capacity for carbapenemase testing means national surveillance data likely underestimate the true pediatric burden. Clinicians were urged to test promptly for resistance mechanisms whenever CRE is isolated in hospitalized children. Standard therapies used against KPC fail against NDM enzymes.
