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ORIGINAL RESEARCH article

Front. Microbiol.

Sec. Infectious Agents and Disease

Volume 16 - 2025 | doi: 10.3389/fmicb.2025.1619611

Epidemiology and outcomes of Carbapenem-resistant Enterobacterales infection in high-risk patients in Saudi Arabia

Provisionally accepted
Basem  M AlraddadiBasem M Alraddadi1Emily  HeaphyEmily Heaphy1*Reem  AlmaghrabiReem Almaghrabi2Sahar  AlthawadiSahar Althawadi2Ahmad  M AlshahraniAhmad M Alshahrani3Salma  AlmosallamSalma Almosallam1Abdullah  AlraddadiAbdullah Alraddadi1Lama  HefniLama Hefni1Mohammad  BosaeedMohammad Bosaeed4Mooza  S AlmannaeiMooza S Almannaei4Ibrahim  BahabriIbrahim Bahabri4Rabab  TahaRabab Taha5Ebtihal  AlamoudiEbtihal Alamoudi6
  • 1King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
  • 2King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
  • 3King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
  • 4King Abdulaziz Medical City, Riyadh, Saudi Arabia
  • 5International Medical Center, Jeddah, Saudi Arabia
  • 6King Abdulaziz University, Jeddah, Saudi Arabia

The final, formatted version of the article will be published soon.

Introduction: Solid organ transplant (SOT) recipients, bone marrow transplant (BMT) recipients, and patients with hematological malignancies suffer from increased morbidity due to developing infections caused by multi-drug-resistant Carbapenem-resistant Enterobacterales (CRE). The current study aims to further describe the epidemiology and outcomes associated with CRE infection in high-risk SOT patients and BMT recipients and in patients with hematological malignancies in Saudi Arabia. Methods: Patients aged 16 years and older admitted to a participating hospital from October 2018 to August 2024 who received a SOT or a BMT or were diagnosed with a hematological malignancy and had a confirmed CRE infection were included in this retrospective cohort study. A total study population of 155 eligible patients were included. The primary outcome of interest was all-cause mortality within 90 days of the date of first CRE culture. Results: Among the 155 patients, 118 (76.1%) had received a solid organ transplant and 37 (23.9%) had a bone marrow transplant or a hematological malignancy. BMT recipients and patients with hematological malignancies were 2.84 times more likely to die within 90 days of their first positive culture (adjusted odds ratio [AOR] = 2.84, 95% confidence interval [CI] = 1.01-8.01, p = 0.049). Compared to patients having CRE infection carrying with the blaNDM gene isolated, after controlling for other predictors, patients with an infection revealing the blaOXA-48 gene isolate were 3.97 times more likely to die within 90 days of the first culture (AOR = 3.97, 95%CI = 1.04-15.15, p =0.044).BMT recipients in comparison to SOT patients and patients with CRE infections harboring the molecular typing of blaOXA-48 gene in their CRE infections were at greater risk for 90 day all-cause mortality in Saudi Arabia, confirming previous findings of a high mortality rate associated with CRE infection in immunocompromised populations.

Keywords: Cre genes, Epidemiology, Bone marrow transplant (BMT), Solid organ transplant (SOT), Enterobacterales

Received: 28 Apr 2025; Accepted: 04 Aug 2025.

Copyright: © 2025 Alraddadi, Heaphy, Almaghrabi, Althawadi, Alshahrani, Almosallam, Alraddadi, Hefni, Bosaeed, Almannaei, Bahabri, Taha and Alamoudi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Emily Heaphy, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia

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