A matched case-control study to assess the carbapenem-resistant Enterobacteriaceae infections among hospitalized children at King Fahad Medical City, Riyadh, Saudi Arabia

OBJECTIVES: To identify risk factors associated with carbapenem-resistant Enterobacteriaceae (CRE) infections among hospitalized children at King Fahad Medical City, Riyadh, Saudi Arabia. METHODS: A retrospective matched case-control study was conducted in pediatric patients with CRE infection at King Fahad Medical City, Riyadh, Saudi Arabia between January 2016-2017. RESULTS: During the study period, 19 CRE cases and 37 controls were identified for analysis. Children ≤17 years (mean age±SD for cases was 43.9±46 months and controls was 29.2±52.2 months) were included in the study. Several factors associated with CRE infections were identified, which included, central venous catheter (CVC) line placement (p=0.023; confidence interval [CI]: 0.97-85.77), recent surgical procedures (p=0.006; CI: 1.30-9.28), invasive procedures (p<0.001; CI: 1.98-21.18), use of prior antibiotics (p=0.008; CI: 1.38-24.62), and carbapenem exposure in the past 3 months (p=0.004; CI: 1.09-12.20). Among the cases, Klebsiella pneumonia was the most commonly identified (47%) followed by Escherichia coli (31%). Carbapenem-resistant Enterobacteriaceae was associated with increased comorbidities and prolonged hospitalization however, no mortalities were reported. CONCLUSION: This study identified prior antibiotic exposure, recent surgery and the use of invasive procedures as significant risk factors for colonization or infection with CRE. Also, the need for public awareness, continuing education for healthcare professionals, optimum use of invasive devices, enhanced surveillance, and antimicrobial stewardship are highlighted here which can limit CRE transmission in healthcare facilities.