Association Between Carbapenem-Resistant Enterobacterales (CRE) Colonization Status at Time of Hospital Admission and the Subsequent Development of CRE Infection and Mortality in High-Risk Patients

Basem M Alraddadi,1,2 Emily LG Heaphy,3 Muhannad S Alzahrani,1 Mouad Alqadi,1 Moayad Sami Qashqari,1 Mohammed S Alhuthali,1 Mohammad Kamal Al Hroub,4 Lama Hefni,1 Abeer N Alshukairi,1,2 Yasser Aldabbagh,5 Mohammed Qutub6 1Medicine Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 2Medicine Department, Al Faisal University, Riyadh, Saudi Arabia; 3Research- Jeddah Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 4Infection Control & Hospital Epidemiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; 5Department of Medicine, Al-Moosa Health Group, Al-Ahsa, Saudi Arabia; 6Pathology and Laboratory Medicine Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi ArabiaCorrespondence: Emily LG Heaphy, King Faisal Specialist Hospital and Research Center- Jeddah, Al Rawdah Road, P.O. Box 40047, Jeddah, 21499, Saudi Arabia, Email [email protected]: The study aimed to determine the impact of Carbapenem-resistant Enterobacterales (CRE) colonization status on development of CRE infection and 30-day mortality outcomes in high-risk patients.Patients and Methods: This retrospective cohort study was conducted at King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia from October 2022 to July 2023. It included all patients aged 14 years and older admitted to the intensive care unit (ICU), the renal transplant unit and the oncology units who were screened for CRE colonization upon hospital admission.Results: Overall, 246 patients comprised the study population and 37 patients (56.8% ICU, 13.5% renal transplant unit, and 29.7% oncology units) had a positive CRE screening test. The majority of the isolates (59.5%) were OXA-48. Almost one-third (32.1%) of the patients had diabetes mellitus and 55.3% had any underlying immunosuppression. Eight (3.3%) patients had a confirmed CRE infection and 35 (14.2%) patients died within 30 days of screening. A positive CRE screening test significantly increased the likelihood of 30-day mortality for this high-risk patient population (adjusted odds ratio [AOR] = 3.06, 95% CI = 1.10– 8.51, p = 0.03).Conclusion: A substantial percentage of the high-risk patients had a positive CRE screening test at the time of hospital admission and CRE-colonization status predicted 30-day mortality. Further studies are needed to determine the best practices for CRE screening as a strategy to prevent infection and mortality.Keywords: carbapenem-resistant enterobacterales, CRE, epidemiology, OXA-48, Saudi Arabia