Evaluating the Clinical Benefit of Carbapenem-Resistant Enterobacteriaceae Screening in a Tertiary Care Center in Saudi Arabia

Ebrahim Mahmoud,1 Abrar Fahad Alhameed,2 Afrah Almukhtar,2 Sameer Desai3 1Division of Infectious Diseases, Department of Medicine, King Faisal Specialist Hospital and Research Center, Madinah, Saudi Arabia; 2Pharmaceutical Care Division, King Faisal Specialist Hospital and Research Center, Madinah, Saudi Arabia; 3Department of Biostatistics, Epidemiology, and Scientific Computing, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi ArabiaCorrespondence: Afrah Almukhtar, Email [email protected]: Limited data exist regarding the risk of infection in patients who test positive during Carbapenem-resistant Enterobacteriaceae (CRE) screening. This study evaluates the clinical impact of CRE screening on infection risk and outcomes in patients with positive screening results.Objective: Compare CRE infection rates between patients with positive and negative CRE screening results.Design: Retrospective, non-experimental descriptive cohort study.Study Setting: Conducted at King Faisal Specialist Hospital and Research Center (KFSHRC), a tertiary care center in Madinah, Saudi Arabia.Subjects and Methods: Over one year, 1070 admitted patients were screened for CRE. Propensity score matching was used to create comparable cohorts of positive and negative screening patients. The study compared the subsequent CRE infection risk, 90-day mortality, total days of hospitalization, ICU admissions, and duration of antibiotic treatment in patients who tested positive for CRE.Main Outcome Measures: CRE infection rates among patients with positive and negative screening results.Results: Propensity score matching resulted in 66 patients with positive CRE screens matched to 133 negative-screen patients. Of those who screened positive, 35% developed a confirmed CRE infection during their hospital stay, compared to 4.6% in the negative group. CRE-positive patients experienced longer hospital stays (mean 21.2 vs 14.7 days, p < 0.001), higher readmission rates (38% vs 19%, p = 0.004), and increased mortality (24% vs 11%, p = 0.019). No significant differences were noted in ICU admission rates.Conclusion: Nearly one-third of patients with positive CRE screening results were at risk of developing subsequent CRE infections. Additionally, positive CRE screening was associated with higher mortality.Limitations: Small sample size and potential selection bias due to screening being performed only in ICU-required patients, potentially skewing results toward poorer outcomes. Findings apply only to hospitalized patients.Plain Language Summary: This study investigated the impact of screening for Carbapenem-resistant Enterobacteriaceae (CRE), which is a type of antibiotic-resistant bacteria, at King Faisal Specialist Hospital and Research Center in Saudi Arabia. The researchers found that patients who tested positive for CRE were more likely to develop serious infections, have longer hospital stays, and face a higher risk of death compared to those who tested negative. These findings highlight the importance of screening in identifying patients who require special care to prevent complications. While the study offers valuable insights, more research is needed to improve how we manage these patients and reduce the spread of CRE in healthcare settings.Keywords: CRE, infection, outcome, risk, screening, Saudi Arabia