A Silent Enemy? Correlation Between Carbapenemase-Producing Enterobacteriaceae Colonization and Subsequent Bacteremia in Pediatric Hematology-Oncology Patients

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Abstract Introduction Infections by multidrug-resistant Gram-negative bacilli (MDR-GNB) result in increased morbidity and mortality among children with cancer. Objectives To determine the prevalence of carbapenemase-producing Enterobacteriaceae (CPE) in rectal swab (RS) cultures in children with cancer and its correlation with blood cultures during bacteremia episodes. Methods Retrospective, descriptive study. It included surveillance rectal swabs for CPE in patients under 18 years of age with cancer at a tertiary care center from 01/01/2024 to 12/31/2024. Bacteremias caused by carbapenemase-producing Gram-negative bacilli (CP-GNB) within 6 months after a positive RS were evaluated. Transplanted patients were excluded. Statistical analysis was performed using R software version 4.3.1. Results A total of 318 RS from 75 patients were included; 20 were positive in 20 patients and 298 were negative in 55 patients. Of the 20 patients with positive RS, 15 had acute lymphoblastic leukemia, 5 had solid tumors, the median age was 106 months (6-170), and females represented 75%. Klebsiella pneumoniae was the most frequently isolated CPE in 9 of 20 RS (45%), followed by Enterobacter cloacae and Escherichia coli in 4/20 RS (20%) each. Eighty-five percent of patients received antibiotic treatment in the 90 days prior to the RS, 18 patients received chemotherapy during the last month, and 7 were neutropenic. The MBL + ESBL resistance mechanism was detected in 17 RS (85%), MBL was detected in 1 case, and KPC in 2 cases. In patients with positive RS, 16 (80%) episodes of GNB bacteremia occurred in 10 patients, of which 5 (31%) were attributed to CP-GNB. Empirical treatment was adequate in 12/16 (75%) episodes. In 4 cases, the resistance mechanism coincided between colonization and infection, representing 25% of the bacteremias: 3 MBL + ESBL and 1 MBL. The median number of days between colonization and bacteremia was 81 (4-109). Two patients died. Among the 298 negative RS in 55 patients, 55 episodes of GNB bacteremia occurred in 36 patients; CP-GNB were isolated in 8 episodes (15%). One patient died. Conclusion CP-GNB bacteremias were more frequent in colonized patients. The MBL + ESBL resistance mechanism predominated. The correlation between RS and infection was most commonly detected within 3 months after colonization. Knowing the colonization status of patients is essential for adequate initial empirical antimicrobial treatment.