<p>Due to immunosuppression and invasive interventions, paediatric oncology patients are at elevated risk for bloodstream infections. Carbapenem-resistant Enterobacterales (CRE) pose a significant therapeutic challenge in this population. Between 1st November 2023 to 31st October 2024, 40 non-duplicate Enterobacterales bloodstream isolates were identified from paediatric oncology patients at a tertiary care centre in Northeast India. Clinical and microbiological data were analysed, including resistance mechanisms, antimicrobial susceptibility, and treatment timelines. <i>Klebsiella pneumoniae</i> (60%) and <i>Escherichia coli</i> (30%) were the predominant pathogens. Carbapenemase activity was detected in 90% of isolates, with NDM detected in 45%, OXA-48 in 25% and co-production of NDM and OXA-48 in 30%, as confirmed via lateral flow assay. Mortality was highest in <i>K. pneumoniae</i> infections (29.2%), though not found statistically significant (p = 0.43). Early initiation of active therapy (&lt; 48&#xa0;h) was significantly associated with reduced 30-day mortality (p = 0.041). Resistance to meropenem exceeded 70%, while ceftazidime-avibactam, its combination with aztreonam, and colistin retained activity in &gt; 85% of isolates. CRE bloodstream infections in paediatric oncology patients are driven by NDM and OXA-48 carbapenemases, with high resistance to first-line agents. Early therapeutic intervention significantly improves survival, underscoring the need for rapid diagnostics and empiric coverage in high-risk settings.</p>