Characterization of Carbapenem-Resistant Enterobacteriaceae Isolates from Pediatric Septicemia Cases in Onitsha, Anambra State, Nigeria

Carbapenem-resistant Enterobacteriaceae (CRE) represent a growing threat to pediatric healthcare due to their association with multidrug resistance, limited therapeutic options, and poor clinical outcomes. This study characterized CRE isolated from pediatric patients with Septicemia. A total of 441 children were studied, from which 159 Enterobacteriaceae isolates were recovered. Blood specimens were processed according to standard microbiological methods. Positive blood cultures were sub cultured and isolates identified to species level using biochemical tests and an automated system VITEK 2. The bacterial isolates were identified using colony morphology (macroscopy), Gram stain reaction (microscopy), and specific confirmatory biochemical tests. The percentage isolates rate was as follows; Escherichia coli (96; 60.4%), Enterobacter cloacae (40; 25.2%), Klebsiella spp. (18; 11.3%), Citrobacter freundii (3; 1.9%), Proteus spp. (1; 0.6%), and Pseudomonas spp. (1; 0.6%). Antimicrobial susceptibility testing revealed high resistance rates to commonly used antibiotics, including β-lactams and carbapenems, with an overall CRE prevalence of 36.05%. Clinically, CRE infections were strongly associated with prior antibiotic exposure, intensive care unit admission, and indwelling device use, and were linked to higher mortality rates among affected children. This study highlights the alarming burden of CRE-associated septicemia among pediatric patients. Enterobacteriaceae isolates underscore the urgent need for routine surveillance, strict antimicrobial stewardship, and strengthened infection prevention and control measures to limit the spread of resistance within pediatric healthcare settings.