High prevalence of blaNDM gene among a series of carbapenem-resistant Enterobacterales isolates from children less than one year old in Niger

Abstract

Carbapenem-resistant Enterobacterales are increasingly reported worldwide, posing significant treatment challenges, especially in vulnerable pediatric populations. This study describes the molecular epidemiology and antimicrobial susceptibility of carbapenem-resistant Enterobacterales isolated from infants under one year of age in Niger. This prospective case series reports on 14 children < 1 year old with carbapenem-resistant Enterobacterales isolates. A total of 14 isolates were analyzed, predominantly Escherichia coli (78.6%; n = 11), followed by Serratia odorifera (7.1%, n = 1), Klebsiella pneumoniae (7.1%, n = 1), and Klebsiella oxytoca (7.1%, n = 1). The blaNDM gene was the most frequently detected carbapenemase, found in 7 isolates (50.0%), followed by blaVIM in 4 isolates (28.6%), blaKPC in 2 isolates (14.3%), and blaOXA−48 in 1 isolate (7.1%). High resistance rates to fluoroquinolones and aminoglycosides were observed, with moderate fosfomycin activity. Cefiderocol, tigecycline, and eravacycline demonstrated preserved activity across carbapenemase genotypes, whereas ceftazidime–avibactam showed limited activity against metallo-β-lactamase producers. An apparent relationship between carbapenemase genotype and multidrug resistance phenotype was observed. Carbapenem-resistant Enterobacterales isolates in infants under one year of age represent a major clinical challenge in Niger. The predominance of blaNDM producing organisms, combined with high levels of resistance to commonly used antibiotics, limits the effectiveness of standard empirical therapies. Cefiderocol and tetracycline derivatives exhibit promising activity and may inform treatment strategies where available. Regional differences in carbapenemase epidemiology underscore the need for enhanced surveillance and stewardship.