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Risk factors, molecular features, and antibiotic susceptibility in carbapenem-resistant Enterobacterales infections among pediatric patients: a matched case-control study Cover

Risk factors, molecular features, and antibiotic susceptibility in carbapenem-resistant Enterobacterales infections among pediatric patients: a matched case-control study

Asian Biomedicine
Volume 20 (2026): Issue 4 (August 2026)
By: ,  ,   and    
Open Access
|Aug 2026
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Figures & tables

Figures & Tables

Figure 1.

Flowchart of this matched case-control study. *Infection from sites other than the ones of interest includes upper respiratory tract specimens, cerebrospinal fluid, gastric content, bone marrow, catheter tips, conjunctival swab, pleural fluid, peritoneal dialysis fluid, breast milk, synovial fluid, and vaginal swab. CRE, carbapenem-resistant Enterobacterales; CSE, carbapenem-susceptible Enterobacterales; yrs, years.

Table 1.

Univariate and multivariate analysis to evaluate risk factors associated with CRE infections

VariablesCRE patients (n = 76)CSE patients (n = 76)Univariate analysisMultivariate analysis
OR (95% CI)PaOR (95% CI)P
Referral from other hospitals44 (57.9%)22 (28.9%)4.14 (1.81–9.45)0.0014.32 (1.57–11.96)0.005
Intensive care unit36 (47.4%)23 (30.3%)2.86 (1.21–6.75)0.017
Comorbidities
  Malignancies13 (17.1%)14 (18.4%)0.86 (0.29–2.55)0.78
  Genitourinary diseases11 (14.5%)17 (22.4%)0.4 (0.13–1.28)0.12
  Hepatobiliary or gastrointestinal diseases21 (27.6%)11 (14.5%)3.0 (1.09–8.25)0.03
  Cardiovascular or respiratory diseases17 (22.4%)11 (14.5%)2.5 (0.78–7.97)0.12
  Neurological or cutaneous diseases13 (17.1%)8 (10.5%)1.83 (0.66–4.96)0.23
Antibiotic exposure in the past 6 months
• Carbapenems47 (61.8%)16 (21.1%)11.0 (3.37–35.87)<0.0017.24 (1.06–25.42)0.002
• Older β-lactam/β-lactamase inhibitors¶48 (63.2%)28 (36.8%)3.86 (1.68–8.86)<0.001
• 3rd generation cephalosporins47 (61.8%)23 (30.3%)4.29 (1.88–9.76)<0.0013.68 (1.32–10.25)0.013
• Fluoroquinolones26 (34.2%)11 (14.5%)4.0 (1.5–10.66)0.01
• Aminoglycosides23 (30.3%)11 (14.5%)3.0 (1.19–7.56)0.02
Multiple hospitalizations37 (48.7%)18 (23.7%)3.25 (1.47–7.18)<0.001
Undergoing major surgery37 (48.7%)26 (34.2%)1.71 (0.89–3.31)0.11
Indwelling medical devices
• Central line44 (57.9%)24 (31.6%)4.33 (1.78–10.53)<0.001
• Arterial line17 (22.4%)11 (14.5%)2.0 (0.75–5.33)0.17
• Nasogastric or orogastric tube42 (55.3%)24 (31.6%)2.7 (1.31–5.58)0.01
• Abdominal drainage21 (27.6%)11 (14.5%)2.11 (0.96–4.67)0.06
Mechanical ventilation27 (35.5%)16 (21.1%)2.83 (1.12–7.19)0.03

[i] CRE, carbapenem-resistant Enterobacterales.

Table 2.

Prevalence of ESBL and carbapenemase genes among 76 CRE isolates

GenesCPE (n = 58)Non-CP-CRE (n = 18)Total (n = 76)
Extended-spectrum beta-lactamase
blaSHV27 (46.6%)8 (44.4%)35 (46.1%)
blaTEM38 (65.5%)11 (61.1%)49 (64.5%)
blaOXA-117 (29.3%)6 (33.3%)23 (30.3%)
blaCTX-M53 (91.4%)14 (77.8%)67 (88.2%)
blaVEB0 (0.0%)0 (0.0%)0 (0.0%)
Carbapenemase
blaNDM35 (60.3%)-35 (46.1%)
blaOXA-4830 (51.7%)-30 (39.5%)
blaNDM + blaOXA-487 (12.1%)-7 (9.2%)
blaIMP0 (0.0%)-0 (0.0%)
blaVIM0 (0.0%)-0 (0.0%)
blaKPC0 (0.0%)-0 (0.0%)

[i] CRE, carbapenem-resistant Enterobacterales; ESBL, extended-spectrum beta-lactamase.

Table 3.

Antibiotic susceptibility profiles of CRE and CSE isolates

CRE isolates (n = 76)CSE isolates (n = 76)
Amikacin (AMK)53 (69.7%)75 (98.7%)
Gentamicin (GEN)38 (50.0%)57 (75.0%)
Ciprofloxacin (CIP)4 (5.3%)32 (42.1%)
Ceftriaxone (CRO)2 (2.6%)48 (63.2%)
Cefepime (FEP)6 (7.9%)58 (76.3%)
Imipenem (IPM)8 (10.5%)76 (100.0%)
Meropenem (MEM)17 (22.4%)76 (100.0%)
Ertapenem (ETP)3 (3.9%)76 (100.0%)
Trimethoprim/sulfamethoxazole (SXT)15 (19.7%)35 (46.1%)
Piperacillin/tazobactam (TZP)1 (1.3%)66 (86.8%)
Amoxicillin/clavulanate (AMC)0 (0.0%)46 (60.5%)

[i] CRE, carbapenem-resistant Enterobacterales; CSE, carbapenem-susceptible Enterobacterales.

Table 4.

Susceptibility rates for selected antibiotics in CRE isolates, categorized into CPE based on carbapenemase genes and non-CP-CRE

Antibiotic agentsblaNDM (n = 35)blaOXA-48 (n = 30)blaNDM + blaOXA-48 (n = 7)Total CPE (n = 58)Non-CP-CRE (n = 18)P
AMK26 (74.3%)16 (53.3%)5 (71.4%)37 (63.7%)16 (88.9%)0.043
GEN18 (51.4%)12 (40.0%)2 (28.6%)28 (48.3%)10 (55.6%)0.589
IPM0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)8 (44.4%)<0.001
MEM0 (0.0%)4 (13.3%)0 (0.0%)4 (6.9%)13 (72.2%)<0.001
ETP0 (0.0%)0 (0.0%)0 (0.0%)0 (0.0%)3 (16.7%)0.002
CZA1 (2.9%)19 (63.3%)0 (0.0%)20 (34.5%)18 (100.0%)<0.001
CST#31 (88.6%)27 (90.0%)5 (71.4%)53 (91.4%)14 (77.8%)0.119
TGC5 (14.3%)4 (13.3%)1 (14.3%)8 (13.8%)2 (11.1%)0.769
FOF15 (42.9%)9 (30.0%)3 (42.9%)21 (36.2%)2 (11.1%)0.043

AMK, amikacin; GEN, gentamicin; IPM, imipenem; MEM, meropenem; ETP, ertapenem; CZA, ceftazidime/avibactam; CST, colistin; TGC, tigecycline; FOF, fosfomycin.

# Using the intermediate breakpoint following the Clinical and Laboratory Standards Institute (CLSI) 2024.

Table 5.

Minimal inhibitory concentrations for selected antibiotics in CRE isolates, categorized as CPE based on carbapenemase genes and non-CP-CRE.

blaNDM (n = 35)blaOXA-48 (n = 30)blaNDM + blaOXA-48 (n = 7)Non-CP-CRE (n =1 8)
MIC50MIC90MIC rangeMIC50MIC90MIC rangeMIC50MIC90MIC rangeMIC50MIC90MIC range
AMK41281–>5124>5120.25–>5124641–128240.5–512
GEN22560.5–>51232>5120.25–>512321282–51211280.125–512
IPM1282564–512162562–51212825664–512240.06–64
MEM1281288–256321280.5–256128128128–128140.06–64
ETP2565124–>5122565122–>512512512256–51282560.5–512
CZA>256/4>256/41/4–>256/41.5/4>256/40.125/4–>256/4>256/4>256/4>256/4–>256/41/42/40.19/4–2/4
CST#180.125–16120125–32181–160.580.25–16
TGC240.25–8480.5–8240.5–8240.125–4
FOF128>5121–>512512>5122–>512>512>5124–>512256>5122–>512

AMK, amikacin; GEN, gentamicin; IPM, imipenem; MEM, meropenem; ETP, ertapenem; CZA, ceftazidime/avibactam; CST, colistin; TGC, tigecycline; FOF, fosfomycin.

# Using the intermediate breakpoint following the Clinical and Laboratory Standards Institute (CLSI) 2024.

Table S1.

Primers for detection of extended-spectrum beta-lactamase genes

GenesPrimer nameSequence (5′-3′)Product size (bp)
blaSHV-likeSHV-FAGGATTGACTGCCTTTTTG392
SHV-RATTTGCTGATTTCGCTCG
blaTEM-likeTEM-CATCAGCAATAAACCAGC516
TEM-HCCCCGAAGAACGTTTTC
blaOXA-1-likeOXA-FATATCTCTACTGTTGCATCTCC619
OXA-RAAACCCTTCAAACCATCC
blaCTX-M-likeCTXM-ACGCTTTGCGATGTGCAG550
CTXM-BACCGCGATATCGTTGGT
blaVEB-likeVEB-ACCTTTTGCCTAAAACGTGGA216
VEB-BTGCATTTGTTCTTCGTTTGC

[i] bp, base pairs.

Table S2.

Primers for detection of carbapenemase genes

GenesPrimer nameSequence (5′-3′)Product size (bp)
blaIMP-likeIMP-FGGAATAGAGTGGCTTAAYTCT188
IMP-RCCAAACYACTASGTTATCT
blaVIM-likeVIM-FGATGGTGTTTGGTCGCATA390
VIM-RCGAATGCGCAGCACCAG
blaOXA-48-likeOXA-48-FGCGTGGTTAAGGATGAACAC438
OXA-48-RCATCAAGTTCAACCCAACCG
blaNDM-likeNDM-FGGTTTGGCGATCTGGTTTTC621
NDM-RCGGAATGGCTCATCACGATC
blaKPC-likeKPC-FCGTCTAGTTCTGCTGTCTTG798
KPC-RCTTGTCATCCTTGTTAGGCG

[i] bp, base pairs.

Table S3.

Susceptibility rates and minimal inhibitory concentrations for studied antibiotics in CRE isolates, grouped by their species

Types of CRETotal isolatesAMKGENCIPCROFEPIPMMEMETPSXTTZPCZACST#TGCFOF
Klebsiella pneumoniae5535 (63.6%)31 (56.4%)3 (5.5%)1 (1.8%)4 (7.3%)4 (7.3%)12 (21.8%)2 (3.6%)11 (20.0%)1 (1.8%)29 (52.7%)47 (85.8%)3 (5.5%)12 (21.8%)
MIC5042128>512512643225664/1216>256/42/412256
MIC90>512>512>512>512>512256128512>512/9728>256/4>256/488>512
MIC range0.25–>5120.125–>5120.125–>5121–>5120.125–>5120.06–5120.06–2560.5–>5120.25/4.75–>512/97284/4–>256/40.125/4–>256/40.125–320.125–816–>512
Escherichia coli1613 (81.3%)5 (31.3%)0 (0.0%)1 (6.3%)1 (6.3%)1 (6.3%)1 (6.3%)0 (0.0%)2 (12.5%)0 (0.0%)4 (25.0%)16 (100%)7 (43.8%)11 (68.8%)
MIC50432256>5125126464256128/2432>256/4>256/40.518
MIC9064128>512>512>512256128512256/4864>256/4>256/411>512
MIC range1–5121–5120.5–>5121–>5122–>5120.5–2560.5–1284–5120.5/9.5–>512/972832/4–>256/40.75/4–>256/40.125–20.25–21–>512
Enterobacter cloacae complex55 (100%)2 (40.0%)1 (20.0%)0 (0.0%)1 (20.0%)3 (60.0%)4 (80.0%)1 (20.0%)2 (40.0%)0 (0.0%)5 (100%)4 (80.0%)0 (0.0%)0 (0.0%)
MIC50481625640.51832/60832/40.75/40.51256
MIC90432>51251251244256256/4864256/42/4162512
MIC range0.5–40.125–320.03–>51264–>5121–>5120.25–40.125–40.5–2560.25/4.75–256/486432/4–256/40.25/4–2/40.25–161–2128–>512
Total CRE isolates7653 (69.7%)38 (50.0%)4 (5.3%)2 (2.6%)6 (7.9%)8 (10.5%)17 (22.4%)3 (3.9%)15 (19.7%)1 (1.3%)38 (50.0%)67 (88.2%)10 (13.2%)23 (30.3%)
MIC5048128>512512323225664/1216>256/4>256/412256
MIC90512512>512>512>512256128512>512/9728>256/4>256/484512
MIC range0.25–>5120.125–>5120.03–>5121–>5120.125–>5120.06–5120.06–2560.5–>5120.25/4.75–>512/97284/4–>256/40.125/4–>256/40.125–320.125–81–>512

AMK, amikacin; GEN, gentamicin; CIP, ciprofloxacin; CRO, ceftriaxone; FEP, cefepime; IPM, imipenem; MEM, meropenem; ETP, ertapenem; SXT, trimethoprim/sulfamethoxazole; TZP, piperacillin/tazobactam; CZA, ceftazidime/avibactam; CST, colistin; TGC, tigecycline; FOF, fosfomycin.

# Using the intermediate breakpoint following the Clinical and Laboratory Standards Institute (CLSI) 2024.

DOI: https://doi.org/10.2478/abm-2026-0029 | Journal eISSN: 1875-855X | Journal ISSN: 1905-7415
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Language: English
Page range: 260 - 271
Published on: Aug 31, 2026
Published by: Chulalongkorn University
In partnership with: Paradigm Publishing Services
Keywords:
anti-bacterial agents,
child,
drug resistance,
Enterobacteriaceae,
microbial sensitivity tests,
risk factors
Related subjects:
Medicine,
Assistive professions, nursing,
Basic medical science,
Basic medical science, other,
Clinical medicine,
Clinical medicine, other

© 2026 Pintip Suchartlikitwong, Naris Kueakulpattana, Jiratchaya Sophonphan, Tanittha Chatsuwan, published by Chulalongkorn University
This work is licensed under the Creative Commons Attribution 4.0 License.

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