Carbapenem-resistant Enterobacteriaceae (CRE) is an important emerging threat among
pediatric cancer patients, with a high mortality rate. This retrospective study included all pediatric
cancer patients with (CRE) bloodstream infections (BSIs) at a children’s cancer hospital in Egypt
(2013–2017). Two hundred and fifty-four pediatric cancer patients with CRE BSI were identified;
74% had hematological malignancies, and 26% had solid tumors. Acute myeloid leukemia was the
most common hematological malignancy (50%). The main clinical features for acquiring CRE-BSI
were previous antibiotics exposure (90%), profound neutropenia (84%), prolonged steroid use (45%),
previous colonization with a resistant pathogen (35%), ICU admission within 90 days (28%), and
central venous catheter use (24%). E. coli was the most common isolated pathogen (56%), followed
by Klebsiella pneumoniae (37%). All isolates were resistant to carbapenem with an MIC < 4–8 µg/mL
in 100 (45%) and >8 µg/mL in 153 (55%). The overall mortality rate was 57%, and 30 day mortality
was reported in 30%. Upon multivariate analysis, for the patients with Klebsiella pneumoniae BSI,
carbapenem resistance with an MIC > 8 µg/mL and associated typhlitis or pneumonia were predictors
of poor outcome. In conclusion, CRE-BSI is a major threat among pediatric cancer patients in limited
resource countries with limited options for treatment. Antimicrobial stewardship for early detection
through routine screening, adequate empirical treatment, and timely adequate therapy may impact
the outcome for such high-risk patient groups.