Risk Factors for the Acquisition of Carbapenemase-Producing <i>Enterobacterales</i> in the Intensive Care Unit of a University Hospital

Background: This retrospective case-control study investigated the incidence and risk factors for carbapenemase-producing Enterobacterales (CPE) acquisition among patients admitted to the intensive care units (ICUs) of a university hospital in Korea.Methods: Between January 1, 2021, and December 31, 2023, a total of 9,381 patients were admitted to the ICUs of a university hospital in Korea.Among these, 2,124 patients underwent at least two active surveillance cultures for carbapenem-resistant Enterobacterales (CRE).Newly acquired CPE colonization was identified in 38 patients, who were classified as the case group.For each case, two non-CRE controls were selected by matching for ICU type and exposure period, resulting in a control group of 76 patients.We analyzed the epidemiological, microbiological, patient-related, and environmental characteristics of patients who acquired CPE, and investigated risk factors associated with CPE acquisition.Results: The proportion of patients who acquired CPE was 1.8%.Klebsiella pneumoniae was the most frequently isolated species, accounting for 68.4% of cases, and bla KPC was the predominant genotype, identified in 89.5% of isolates.The median time from ICU admission to CPE acquisition was 14 days.In multivariable analysis, independent risk factors for CPE acquisition included prior carbapenem use (adjusted OR: 6.23, 95% CI 1.59-24.38),colonization with multidrug-resistant organisms (adjusted OR: 9.34,, staying for more than three days in a bed within two meters of a hand hygiene faucet (adjusted OR: 7.94, 95% CI 1.45-43.44),and a higher ICU CRE incidence (adjusted OR: 1.60, 95% CI 1.11-2.30).Conclusion: These findings highlight the importance of implementing targeted infection control measures and active surveillance to prevent CPE acquisition in ICU settings.