Faecal carriage of multidrug-resistant Enterobacterales in hospitalisaed and outpatient children in northern India: A cross-sectional study.

Abstract

Background: Asymptomatic intestinal carriage of multidrug-resistant (MDR) Enterobacterales in children is increasingly recognised as an important reservoir for transmission and subsequent infection. However, data from northern India remain limited, warranting evaluation of its burden and associated risk factors.

Objective: To determine the prevalence of MDR Enterobacterales carriage among children and to identify associated risk factors, including recent hospitalisation, antimicrobial exposure, and hygiene practices.

Methods: This cross-sectional study was conducted at a tertiary care hospital in northern India from January to June 2025. Children aged ≤ 14 years were enrolled after obtaining informed consent from parents or legal guardians. A total of 340 stool samples were processed using standard microbiological methods. Bacterial identification was performed using conventional biochemical tests, and antimicrobial susceptibility testing was carried out according to Clinical and Laboratory Standards Institute guidelines, 2025 edition. Multidrug-resistant was defined as resistance to at least one agent in three or more antimicrobial classes. Demographic and clinical data were analysed using SPSS version 25.0; p < 0.05 was considered statistically significant.

Results: Among 340 enrolled children, Enterobacterales were isolated from 309 (90.9%). Multidrug-resistant Enterobacterales were identified in 87 children, yielding a prevalence of 28.2% among Enterobacterales-positive children and 25.6% overall. Escherichia coli (66.7%) and Klebsiella spp. (33.3%) were the predominant MDR organisms. Extended-spectrum β-lactamase production was detected in 18.1% of isolates. Multidrug-resistant carriage was significantly higher among inpatients (p < 0.001).

Conclusion: Asymptomatic carriage of MDR Enterobacterales is common, particularly among hospitalised children, highlighting the importance of strengthened antimicrobial stewardship and infection prevention strategies in paediatric care.

What this study adds: This study demonstrates a high prevalence of asymptomatic multidrug-resistant Enterobacterales carriage among children in northern India, particularly among hospitalised children, highlighting the need for ongoing surveillance, infection prevention and antimicrobial stewardship.