Risk-Based Pre-Admission Screening for Carbapenem-Resistant Enterobacterales (CRE): A Patient-Level Observational...

Multidrug-resistant organisms, particularly carbapenem-resistant Enterobacterales (CRE), represent a major global health threat. In settings with endemic circulation of carbapenem-resistant organisms, early identification of colonised patients before hospital admission may play a critical role in limiting in-hospital spread and guiding infection prevention strategies. We conducted a retrospective monocentric observational study including all patients evaluated for hospital admission in 2025. Patients presenting predefined epidemiological or clinical risk factors underwent risk-based pre-admission screening for CRE. Patient-level deduplication was applied to microbiologically positive records. Among 2694 patients evaluated for hospital admission, 1084 met predefined screening criteria and underwent rectal swab testing. Overall, 191 unique patients were confirmed as carriers of carbapenemase-producing Enterobacterales, corresponding to 17.6% of screened patients and 7.1% of the overall cohort evaluated for admission. KPC was the most prevalent carbapenemase gene (102/191, 53.4%), followed by NDM (57/191, 29.8%) and KPC/NDM co-production (14/191, 7.3%). Less frequent gene profiles included VIM, OXA-48, and combined carbapenemase patterns. In high-endemic healthcare settings, risk-based pre-admission screening may represent a pragmatic component of infection prevention pathways by supporting early identification of patients with probable CRE/CPE carriage. When analysed at the patient level, such programmes can provide useful operational and epidemiological information for admission management and infection control planning.