From Colonisation to Infection: Assessing the BSI Potential in Patients with KPC, NDM, VRE and CRAB Rectal...

Area of Science:

• Infectious Diseases
• Clinical Microbiology
• Hospital Epidemiology

Background:

• Nosocomial infections are frequently caused by multi-drug-resistant organisms (MDROs).
• Key MDROs include carbapenem-resistant Enterobacterales (KPC, NDM), carbapenem-resistant Acinetobacter baumannii (CRAB), and vancomycin-resistant Enterococcus faecium (VRE).
• Patients colonized with MDROs face a heightened risk of developing bloodstream infections (BSIs).

Purpose of the Study:

• To investigate the risk factors associated with developing bloodstream infections (BSIs) in patients colonized with specific MDROs.
• To identify which MDROs and patient characteristics correlate with increased BSI risk.
• To inform the development of targeted prevention strategies for high-risk patient groups.

Main Methods:

• Retrospective study of patients with rectal colonization by KPC, NDM, VRE, or CRAB.
• Data collected from medical, surgical, and ICU wards between January 2019 and October 2024.
• Logistic regression analysis used to identify independent risk factors for BSI development.

Main Results:

• Overall BSI rate was 9.4% among 1960 hospitalizations with specific MDRO colonizations.
• CRAB (20.0%) and KPC (12.6%) exhibited the highest BSI rates.
• ICU hospitalization increased BSI risk for KPC, NDM, and VRE. Hematological malignancies/transplants and solid organ transplants were independent risk factors for specific MDRO BSIs.

Conclusions:

• BSI risk varies significantly among different MDROs, with CRAB and KPC being most critical.
• Patients in ICUs and those with hematological or solid organ transplants are particularly vulnerable.
• Findings underscore the need for tailored prevention strategies for critically ill and immunocompromised patients.