intestinal carriage of carbapenemase-producing enterobacteriaceae members in immunocompromised children during covid-19 pandemic

Hospital-acquired infection with carbapenem-resistant enterobacteriaceae (cre) is a global concern. the adminis-tration of antibiotics among the infected and non-infected immunocompromised children with sars-cov-2 is associated with an increased risk of intestinal cre colonization and bacteremia during hospitalization.objectives: the present study aimed to detect the correlation between the intestinal colonization of carbapenemase encoding enterobacteriaceae with sars-cov-2 infection and antibiotic prescription among immunocompromised children admitted to the oncology and bone marrow transplantation (bmt) wards.methods: stool samples were collected from the immunocompromised children, and the members of enterobacteriaceae were iso-lated using standard microbiological laboratory methods. carbapenem resistance isolates were initially characterized by the disc di usion method according to clsi 2021 and further confirmed by the pcr assay. sars-cov-2 infection was also recorded according to documented real-time pcr results.results: in this study, 102 enterobacteriaceae isolates were collected from the stool samples. the isolates were from escherichia spp.(59/102, 57.8%), klebsiella spp. (34/102, 33.3%), enterobacter spp. (5/102, 4.9%), citrobacter spp. (2/102, 1.9%), and serratia spp. (2/102, 1.9%). the carbapenem resistance phenotype was detected among 42.37%, 73.52%, 40%, 50%, and 100% of escherichia spp., klebsiella spp., enterobacter spp., citrobacter spp., and serratia spp., respectively. moreover, blaoxa-48 (49.1%) and blandm-1 (29.4%), as well as blavim (19.6%) and blakpc (17.6%) were common in the cre isolates. sars-cov-2 infection was detected in 50% of the participants; however, it was confirmed in 65.45% (36/55) of the intestinal cre carriers. the administration of antibiotics, mainly broad-spectrum antibiotics, had a significant correlation with the cre colonization in both the infected and non-infected children with sars-cov-2 infection. conclusions: regardless of the covid-19 status, prolonged hospitalization and antibiotic prescription are major risk factors asso-ciated with the cre intestinal colonization in immunocompromised children.