Carbapenemase-producing Enterobacterales: An Increasing Risk in Pediatrics?

Session Description: As travel has become faster and easier, the world has become a much smaller place. The increase in international medicine programs and medical tourism has led to new challenges for Infection Prevention and Control (IPC) programs. Resistant organisms such as, New Delhi Metallo-β -Lactamase Carbapenem Resistant Enterobacterales (NDM-CRE), are becoming more prevalent outside the United States, but cases remain rare in pediatric patients. This presentation will describe two separate cases of NDM-CRE identified within three weeks of each other in a pediatric hospital that had never previously identified a case.

Between January 2022 and June 2023, 375 international patients were seen for destination care in our facility, spanning every department/specialty. Additional descriptive data are presented, such as the distribution of countries of origin, medical diagnosis and average length of stay. The prevalence rates and geographical distribution of NDM-CRE will lead into a discussion of the importance of antimicrobial stewardship programs. Next, the two cases of NDM-CRE will be presented. The highlights, similarities, and differences will be identified. The recommendations from IPC are then described, which included collaboration with the Department of Health, who recommended a Point Prevalence Survey (PPS) for each unit. The tools that IPC used for these PPS, including family communication and frequently asked questions, will then be shared. The results of the PPS will be presented, showing that one unit had much higher participation than the other (12.5% versus 100%). Possible reasons for the discrepancy will be presented. Zero new cases of NDM-CRE were identified on these units or elsewhere in the hospital. The presentation ends with a discussion around our experience and lessons learned.