The Journal of hospital infection · 2026
Admission status is not destiny: serial surveillance reveals ecologic and in-hospital drivers of carbapenem-resistant Enterobacterales colonization in critical care.
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de Almeida Lessa Castro B, Pereira Alves Madeira Bezerra C L, Lino Dos Santos Júnior E, Freire M P, Levin A S, Cury A P, Rossi F, Bollinger S, Lessa F C, Mahon G, Westercamp M, Salomão M C, ICTeam
Аннотация
BACKGROUND: Identifying risk factors for gastrointestinal carbapenem-resistant Enterobacterales (CRE) colonization and acquisition is essential for guiding infection prevention and control strategies; however, most studies focus exclusively on colonization at hospital admission.
AIM: We aimed to distinguish determinants of CRE colonization present at intensive care unit (ICU) admission from those driving acquisition during ICU stay using serial surveillance screening.
METHODS: A prospective cohort study was conducted in two ICUs in Brazil. Screening relied on rectal swab cultures from April 2022 to May 2024, supplemented with immunochromatographic testing in one ICU and polymerase chain reaction in the other during October 2023-May 2024. Colonization at admission and incident acquisition during stay were outcomes of interest. Pre-ICU predictors were evaluated using logistic regression with least absolute shrinkage and selection operator selection, whereas post-ICU factors were assessed through generalized estimating equations.
FINDINGS: Among 751 patients, 39 (5%) were colonized with CRE at ICU admission. Previous acute care hospitalization (odds ratio [OR] = 2.70; P = 0.006) and transfer from another hospital (OR = 2.62; P = 0.046) were independent risk factors. Post-ICU-admission incident CRE colonization was associated with ICU B stay (OR = 2.20; P = 0.013), broad-spectrum antibiotics (OR = 1.90; P = 0.018), urinary catheter use (OR = 2.33; P = 0.024), and shock (OR = 1.91; P = 0.043). Hand hygiene compliance and contact precautions adherence were >80% across both units.
CONCLUSION: CRE acquisition in ICU appears related to colonization pressure, antibiotic disruption, and specific device use. Prevention of CRE acquisition in high-prevalence ICUs likely requires interventions beyond standard infection prevention and control measures.
AIM: We aimed to distinguish determinants of CRE colonization present at intensive care unit (ICU) admission from those driving acquisition during ICU stay using serial surveillance screening.
METHODS: A prospective cohort study was conducted in two ICUs in Brazil. Screening relied on rectal swab cultures from April 2022 to May 2024, supplemented with immunochromatographic testing in one ICU and polymerase chain reaction in the other during October 2023-May 2024. Colonization at admission and incident acquisition during stay were outcomes of interest. Pre-ICU predictors were evaluated using logistic regression with least absolute shrinkage and selection operator selection, whereas post-ICU factors were assessed through generalized estimating equations.
FINDINGS: Among 751 patients, 39 (5%) were colonized with CRE at ICU admission. Previous acute care hospitalization (odds ratio [OR] = 2.70; P = 0.006) and transfer from another hospital (OR = 2.62; P = 0.046) were independent risk factors. Post-ICU-admission incident CRE colonization was associated with ICU B stay (OR = 2.20; P = 0.013), broad-spectrum antibiotics (OR = 1.90; P = 0.018), urinary catheter use (OR = 2.33; P = 0.024), and shock (OR = 1.91; P = 0.043). Hand hygiene compliance and contact precautions adherence were >80% across both units.
CONCLUSION: CRE acquisition in ICU appears related to colonization pressure, antibiotic disruption, and specific device use. Prevention of CRE acquisition in high-prevalence ICUs likely requires interventions beyond standard infection prevention and control measures.