Asymptomatic gastrointestinal carriage of multidrug-resistant carbapenemase-producing Enterobacteriaceae among children under five years in a Kenyan hospital

Objectives: Asymptomatic gastrointestinal carriage of carbapenem-resistant Enterobacteriaceae (CRE) is a threat to global health in developing countries with inadequate safe drinking water, poor hygiene, and weak antimi-crobial stewardship; however, epidemiological data to guide CRE infection prevention and control is limited in these settings. We assessed asymptomatic CRE and carbapenem-producing Enterobacteriaceae (CPE) fecal car-riage rates and associated risk factors among hospitalized children aged under 5 years.Methods: We adopted a cross-sectional study at Mama Lucy Kibaki Hospital in Nairobi-City County, Kenya, be-tween June and September 2022. We collected demographic and clinical characteristics using a structured ques-tionnaire and clinical reports and analyzed stool/rectal swab samples by standard and automated bacteriological methods.Results: Asymptomatic CRE and CPE fecal carriage rate was 2.25% (6/267), with six isolates recovered, pre-dominated by Escherichia coli (33.33%) and Enterobacter cloacae subsp dissolvens (33.33%). Third-generation cephalosporin and ciprofloxacin resistance were highest in Citrobacter farmer and E. cloacae subsp cloacae. All CRE and CPE were multidrug-resistant, and except E. cloacae subsp cloacae, were 100% colistin-resistant.Conclusions: Asymptomatic gastrointestinal carriage of multidrug-resistant-CRE among hospitalized children un-der 5 years, presents a substantial public health threat. This calls for continuous surveillance including molecular characterization of isolates, to inform infection prevention and antimicrobial stewardship adherence in line with local and global plans on AMR.