The Likelihood of Developing a Carbapenem-Resistant Enterobacteriaceae Infection during a Hospital Stay

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Microbiology

Background:

• Carbapenem-resistant Enterobacteriaceae (CRE) pose a significant threat in healthcare settings, particularly in intensive care units (ICUs).
• Understanding the incidence and progression of CRE colonization is crucial for infection control strategies.

Purpose of the Study:

• To determine the incidence of rectal CRE colonization on admission to U.S. ICUs.
• To assess the rate and timing of new-onset CRE colonization among patients initially negative for CRE.
• To evaluate the association between carbapenemase-producing CRE colonization and subsequent CRE infections.

Main Methods:

• Prospective study involving 1,455 unique patients admitted to U.S. ICUs.
• Rectal swabs collected on admission and during ICU stay for patients initially negative for CRE.
• Analysis of time to colonization and development of CRE infections.

Main Results:

• 4% of ICU patients were rectally colonized with CRE on admission.
• Among 297 patients initially CRE-negative, 22% developed subsequent colonization, with a median time of 13 days.
• Patients colonized with carbapenemase-producing CRE had a significantly higher risk of developing CRE infections (36%) compared to those with non-carbapenemase-producing CRE (3%).

Conclusions:

• A substantial proportion of ICU patients acquire CRE during their hospitalization.
• Carbapenemase-producing CRE colonization is a strong predictor of subsequent CRE infections.
• Enhanced surveillance and infection control measures are warranted to mitigate CRE transmission in ICUs.