Carbapenem-Resistant Gram-Negative Bacteria Colonization in Immunocompromised and Critically Ill Pediatric Patients: Prevalence, Risk Factors, and Outcomes

Background: Carbapenem-resistant Gram-negative bacteria (CRGNB), including carbapenem-resistant Enterobacteriaceae (CRE) and Acinetobacter baumannii (CRAB) poses significant risks to immunocompromised and critically ill patients. Methods: A cross-sectional study was conducted at a tertiary care university hospital in Bangkok, Thailand (May 2023-October 2024). Hospitalized patients under 20 years of age who were immunocompromised or critically ill were enrolled. Rectal swabs were collected within 48 hours of admission. Results: Among 302 participants, 29 (9.6%) were colonized with CRGNB, including 19 (65.5%) with CRE and 10 (34.5%) with CRAB. Independent risk factors included recent surgery (adjusted OR 7.6, P = .006), hospital referral (aOR 3.03, P = .043), and younger age (aOR 0.86, P = .02). Colonized patients had longer hospital stays (median 12 days vs 6 days, P = .001) and higher mortality (17.2% vs 5.5%, P = .022). Conclusion: CRGNB colonization was identified in nearly 10% of high-risk pediatric patients and associated with unfavorable outcomes. Early identification and targeted infection control are essential.