Comparison of carbapenemase-producing <i> </i><i>Enterobacterales</i> colonizing war-affected children from the Gaza Strip and hospitalized children from a national reference center in Qatar: An observational cohort study

<h3>Objectives</h3><p dir="ltr">To compare the rates and molecular characteristics of carbapenemase-producing Enterobacterales (CPE) from rectal screening swabs in war-affected Palestinian children in the Gaza Strip with those of the local pediatric population at Sidra Medicine in Doha.</p><h3>Methods</h3><p dir="ltr">Whole-genome sequencing was performed on CPE isolated in screening specimens of Gazan children transferred to our institution from Egyptian hospitals between December 2023 and May 2024 (Gaza cohort) and other pediatric patients between January 2021 and May 2024 (Sidra Cohort). </p><h3>Results</h3><p dir="ltr">The Sidra cohort included 84 CPE isolates from 79 carriers, while the Gaza cohort included 53 isolates from 41 carriers. The Gaza cohort showed a 41.9-fold (95% CI: 22.7-81.6) higher crude incidence rate ratio of colonization. In Sidra cohort, 71 carriers (89.9%) had pre-existing medical conditions, compared to 29 (70.7%) Gazan carriers who had no pre-existing medical conditions before the armed conflict between Hamas and Israel began in October 2023. Thirty-two (78.0%) Gazan carriers sustained war-related injuries, with 31 (96.7%) of these patients undergoing at least one surgery in Gaza or Egypt. In the Gaza collection, 47 (88.7%) isolates displayed difficult-to-treat resistance phenotype (DTR), while 32 (38.1%) Sidra isolates exhibited this phenotype. NDM-like carbapenemases predominated in the Gaza collection (49 isolates; 92.5%), while OXA-48-like were most prevalent in the Sidra collection (41 isolates; 48.8%). <i>Klebsiella pneumoniae </i>and<i> Escherichia</i> coli populations in the Gaza collection were dominated by the high-risk clones ST147 (15/19; 78.9%) and ST167 (13/30; 43.3%). Pairwise single-nucleotide polymorphism analysis of these genotypes revealed genetic diversity, suggesting different sources and transmission chains among Gazan carriers. </p><h3>Conclusions </h3><p dir="ltr">Our study revealed a high CPE colonization rate among war-affected Palestinian children and highlights the potential risk posed by conflict-related health emergencies in the silent spread of multidrug-resistant organisms, particularly high-risk global lineages exhibiting DTR, within the healthcare systems of host countries.</p><h2>Other Information</h2><p dir="ltr">Published in: Clinical Microbiology and Infection<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="https://dx.doi.org/10.1016/j.cmi.2025.08.026" target="_blank">https://dx.doi.org/10.1016/j.cmi.2025.08.026</a></p>