CARBAPENEM-RESISTANT ENTEROBACTERIACEAE IN PAEDIATRIC BLOODSTREAM INFECTIONS IN SUB-SAHARAN AFRICA

Background: Carbapenem-resistant Enterobacterales (CRE) are a WHO critical-priority threat, and children in sub-Saharan Africa (SSA) carry a disproportionate share of the burden. Carbapenems are the last reliable β-lactams for multidrug-resistant Gram-negative sepsis, so resistance leaves few, often unavailable, options for sick children. Aim: To synthesise evidence on the epidemiology, resistance mechanisms, risk factors, clinical consequences, laboratory detection and management of CRE bloodstream infections (BSIs) in children in SSA, with emphasis on Nigeria. Main findings: Gram-negative organisms, led by Klebsiella pneumoniae, Escherichia coli and Enterobacter spp., cause a large share of paediatric and neonatal BSIs in SSA. Across studies, carbapenem resistance ranges from under 10% in some general paediatric series to over 40% of Gram-negative isolates in some tertiary neonatal units. Metallo-β-lactamases, particularly NDM variants, and OXA-48-like enzymes (including OXA-181) dominate in the region, while KPC is uncommon. Neonates, especially preterm and very-low-birth-weight infants in intensive care, are most affected; prior antibiotic exposure, prolonged admission, invasive devices and gut colonisation are key risk factors. CRE BSI is associated with higher crude mortality, prolonged admission and heavy reliance on toxic or unavailable reserve drugs. Phenotypic tests such as the modified Hodge test miss many NDM producers, and molecular confirmation is rarely available outside research settings. Conclusion: Paediatric CRE BSI in SSA is an established, under-measured problem driven largely by nosocomial transmission of MBL-producing clones. Priorities are sustained paediatric surveillance with molecular typing, affordable carbapenemase detection, neonatal infection prevention, carbapenem stewardship, and access to paediatric-appropriate reserve antibiotics.