AUTHOR=Guo Bo , Guo Ziqi , Zhang Huifeng , Shi Chuanchuan , Qin Bingyu , Wang Shanmei , Chang Yinjiang , Chen Jian , Chen Peili , Guo Limin , Guo Weidong , Han Huaibin , Han Lihong , Hu Yandong , Jin Xiaoye , Li Yening , Liu Hong , Lou Ping , Lu Yibing , Ma Panfeng , Shan Yanhua , Sun Yiyi , Zhang Wukui , Zheng Xisheng , Shao Huanzhang 

TITLE=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

JOURNAL=Frontiers in Microbiology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2022.894341

DOI=10.3389/fmicb.2022.894341

ISSN=1664-302X

ABSTRACT=Objective: In intensive care units (ICUs), carbapenem-resistant Enterobacterales (CRE) pose a significant threat. We aimed to examine the distribution, epidemiological characteristics and risk factors for CRE positivity in ICUs. 
Methods: This cross-sectional study was conducted in 96 ICUs of 78 hospitals in Henan Province, China. The clinical and microbiological data were collected. A multivariable logistic regression model was used to analyze the risk factors for CRE positivity. 
Results: A total of 1009 patients were enrolled. There was a significant difference in CRE positive rate between pharyngeal and anal swabs (15.16% vs. 19.13%, P=0.021). A total of 297 carbapenem-resistant Klebsiella pneumoniae (CR-KPN), 22 carbapenem-resistant Escherichia coli (CR-ECO), 6 carbapenem-resistant Enterobacter cloacae (CR-ECL), 19 CR-KPN/CR-ECO, and 2 CR-KPN/CR-ECL were detected. Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-beta-lactamase (NDM), and a combination of KPC and NDM were detected in 150, 9, and 11 swab samples, respectively. Multivariable logistic regression analysis determined length of ICU stay, chronic neurological disease, transfer from other hospitals, previous infection, and history of antibiotics exposure as independent risk factors for CRE positivity. The occurrence of CRE in secondary and tertiary hospitals was 15.06% and 25.62%, respectively (P<0.05). Patients from tertiary hospitals had different clinical features compared with those from secondary hospitals, including longer hospital stay, a higher rate of patients transferred from other hospitals, receiving renal replacement therapy, exposure to immunosuppressive drugs, use of antibiotics, and a higher rate of previous infection.
Conclusions: In ICUs in Henan Province, CRE positive rate was very high, mostly KPC-type CR-KPN. Patients with prolonged ICU stay, chronic neurological disease, transfer from other hospitals, previous infection, and history of antibiotic exposure are prone to CRE. The CRE positive rate in tertiary hospitals was higher than that in secondary hospitals, which may be related to the source of patients, antibiotic exposure, disease severity, and previous infection.