The importance of active surveillance of carbapenem-resistant Enterobacterales (CRE) in colonization rates in critically ill patients

Abstract

Objective This study aimed to demonstrate the importance of active carbapenem-resistant Enterobacterales (CRE) surveillance and evaluate the prevalence of invasive infections, risk factors, and mortality risk in CRE-colonized patients. Methods Retrospective cohort study analyzing 1,920 patients identified using an active CRE surveillance protocol, admitted to an adult intensive care unit in southeastern Brazil from January 2014 to December 2018. Results There were 297 (15.47%) CRE colonized patients, with one colonized for every six control patients. CRE-colonized patients demonstrated an increased chance of infection (odds ratio [OR] 7.967, p < 0.001). Overall, 20.54% of the colonized patients presented invasive infection (81.96% due to Klebsiella pneumoniae). The colonization and infection ratio demonstrated the important role of the active CRE surveillance protocol. There were identified multiple risk factors for CRE colonization, including long-term mechanical ventilation (OR 1.624, p = 0.019) and previous exposure to aminopenicillins (OR 5.204, p < 0.001), carbapenems (OR 3.703, p = 0.017), cephalosporins (OR 12.036, p < 0.001), and fluoroquinolones (OR 5.238, p = 0.012). The mortality risk was significantly higher among colonized (OR 2.356, p < 0.001) and colonized-infected (OR 2.000, p = 0.009) patients and in those with Enterobacter cloacae colonization (OR 5.173, p < 0,001) and previous aminopenicillins exposure (OR 3.452, p = 0.007). Conclusions Early detection of CRE colonization through screening testing proved to be an important tool to control CRE spread. However, observation over the years has shown no effective control of colonization and infection. The prevalence rates of CRE colonization and colonization-infection were high, as were the mortality rates. In conclusion, an active CRE surveillance protocol is essential, but its impact depends on the effective implementation of preventive measures and feedback between team members.

Prevalence and risk factors of carbapenem-resistant Enterobacterales positivity by active screening in intensive care units in the Henan Province of China: A multi-center cross-sectional study

“…The presence of CRE colonization is a risk factor for CRE infection (Shu et al, 2020), which may increase the 10. 3389/fmicb.2022.894341 prevalence of CRE infection (Lin et al, 2021;Yin et al, 2021;Gomides et al, 2022). In addition, CRE colonization or infection was associated with longer hospital stays and an overall mortality of 10% (Tischendorf et al, 2016).…”

Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units: A single center, before-after study

“…Our study found that CRO incidence was 11.68% and 9.2% (4.78% and 2.73% for CRKP, 5.24% and 3.48% for CRE, 6.83% and 5.67% for CRAs, and 2.45% and 1.79% for CRPA) in the active surveillance-positive and -negative groups, respectively. Several studies have already addressed the epidemiology and incidence of CRE and CRAs [6,10,[16][17][18][19][20], while one study has reported the drug resistance phenotype and molecular epidemiological characteristics of CPKP in children [21]. Our results demonstrate that early active surveillance of carbapenem resistance genes can effectively block the transmission of CRO in the ICU and should provide support for other healthcare facilities that are working to reduce the burden of CRO in their patient populations; these ndings are consistent with those of previous studies [22,23].…”

“…Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter (CRAs), and carbapenem-resistant P. aeruginosa (CRPA) in healthcare facilities indicate that patients should be actively screened when they enter the hospital for treatment or after exposure to risk to avoid delayed treatment [7]. Active surveillance of CRO infection and surveillance cultures of asymptomatic CRO colonization allows the early introduction of infection prevention and control measures to prevent transmission to other patients and the environment [8][9][10][11].…”

Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units

“…Our study found that CRO incidence was 11.68% and 9.2% (4.78% and 2.73% for CRKP, 5.24% and 3.48% for CRE, 6.83% and 5.67% for CRAs, and 2.45% and 1.79% for CRPA) in the active surveillance-positive and -negative groups, respectively. Several studies have already addressed the epidemiology and incidence of CRE and CRAs 6 , 10 , 16 – 20 , while one study has reported the drug resistance phenotype and molecular epidemiological characteristics of CPKP in children 21 . Our results demonstrate that early Xpert Carba-R surveillance of carbapenem resistance genes is associated with reduction of the incidence of CRO in the ICU and should provide support for other healthcare facilities that are working to reduce the burden of CRO in their patient populations; these findings are consistent with those of previous studies 22 , 23 .…”