Clinical, microbiological characteristics and outcomes of carbapenemase-producing enterobacterales bloodstream infections in a pediatric hospital in Brazil

The incidence of carbapenemase-producing Enterobacterales (CPE) infections has been rising globally and is associated with high morbidity and mortality. However, data on CPE bloodstream infections (BSIs) in pediatric populations remain limited. This retrospective, single-center observational study included pediatric patients diagnosed with CPE BSI between August 2019 and December 2024 at a tertiary care hospital in southern Brazil. Demographic, clinical, and microbiological data were analyzed, along with outcomes including 30-day mortality, need for pediatric intensive care unit (PICU) admission, and length of hospital stay. A total of 41 episodes of CPE BSI were identified in 39 patients. Among them, 65.8% had a chronic illness, 41.5% were immunosuppressed, and 97.6% had a central venous catheter. Klebsiella pneumoniae was the most frequently isolated pathogen. Carbapenemase production included KPC (58.5%), NDM (36.6%), and co-production of both enzymes (4.9%). The 30-day mortality rate was 25.6%, rising to 47.0% in patients with sepsis (p = 0.011). Carbapenem use in the previous 3 months were significantly associated with lower mortality (p = 0.008). CPE BSI in pediatric patients primarily affects those with underlying illnesses, immunosuppression, or prior healthcare exposure, and is associated with high mortality. These findings underscore the need for targeted prevention, early detection, and optimized management strategies in this vulnerable population.