Incidence and Risk Factors for Recurrence of NDM- and KPC-Producing Enterobacterales after Achieving Clearance: A...

We aimed to determine the incidence and risk factors of recurrence after clearance of carbapenemase-producing Enterobacterales (CPE). We also sought to investigate whether there were differences in recurrence according to carbapenemase type.

We conducted a retrospective case-control study (From January 2022 to December 2023) at a tertiary referral hospital in Korea. Recurrence was defined as positive culture or PCR test results for CPE with the same genotype as the first CPE isolation within 1 year after clearance.

Among 1,503 patients with New Delhi metallo-β-lactamase (NDM)- or Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales in whom clearance status could be assessed, 569 (37.8%) achieved clearance. Clearance was observed in 349 of 749 patients (46.6%) with NDM-producing isolates and 220 of 754 patients (29.2%) with KPC-producing isolates (P<0.001). Recurrence occurred in 65/569 (11.4%) patients after clearance - 34/349 (9.7%) in NDM group and 31/220 (14.1%) in the KPC group (P=0.112). Multivariate analysis identified central venous catheter dwelling after clearance as an independent risk factors for CPE recurrence (adjusted odds ratio [aOR], 2.27; 95% confidence interval [CI], 1.16-4.43; P=0.016).

Recurrence occurred in approximately one out of ten patients after clearance within one year, and did not differ significantly by carbapenemase type. Post-clearance indwelling devices, particularly central venous catheters, were associated with recurrence, underscoring the need for targeted infection control strategies after documented clearance.