Predictive performance of weekly rectal surveillance cultures and extra-rectal colonization for carbapenem-resistant Enterobacterales infections in a resource-limited ICU with KPC and NDM co-circulation.

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Title:	Predictive performance of weekly rectal surveillance cultures and extra-rectal colonization for carbapenem-resistant Enterobacterales infections in a resource-limited ICU with KPC and NDM co-circulation.
Alternate Title:	Rendimiento predictivo de los cultivos de vigilancia rectal semanales y de la colonización extra-rectal para infecciones por enterobacterias resistentes a carbapenémicos en una UCI con co-circulación de KPC y NDM en un entorno con recursos limitados
Authors:	Favier, Patricio¹ patriciofavier@hotmail.com, Suárez-Urquiza, Pedro², Raffo, Carla³, Torres, Diego³, Kumar, Liliana⁴, Pérez, Johanna⁵, Primost, Ivana⁶, Inés Gallino, María⁶, Pinilla-Huayta, Fidel³, Muñoz-Soto, Claudia³, Ravelli, Matías³, Serio, Enrique³, Pemán-García, Javier⁷, Valentín-Martín, Amparo², María González-Barberá, Eva²
Source:	Revista Española de Quimioterapia. feb2026, Vol. 39 Issue 1, p49-60. 12p.
Subjects:	CARBAPENEM-resistant bacteria, COLONIZATION (Ecology), INTENSIVE care units, PREDICTIVE validity, CARBAPENEMASE, BACTEREMIA
Abstract (English):	Background: Carbapenem-resistant Enterobacterales (CRE) cause hard-to-treat infections. Rectal surveillance is widely used to detect carriers, but its predictive value where different carbapenemases co-circulate is unclear. We assessed whether CRE rectal and extra-rectal colonization predicts subsequent infection in an intensive care unit with concurrent KPC and NDM circulation. Methods: We performed a retrospective observational study in a 60-bed adult intensive care unit in Buenos Aires, Argentina, from July 2016 to September 2019. All patients underwent weekly rectal surveillance, and extra rectal samples were taken when clinically indicated. Following up lasted 90 days from the first positive culture or from admission for non-carriers. Outcomes were any CRE infection and bacteremia. We estimated predictive values and fitted multivariable logistic regression models. Results: We included 495 patients, median age 66 years, 58% male. Of them, 66% had rectal colonization and 8% had extrarectal colonization. CRE rectal carriage showed low PPV for any infection, about 10%, with high NPV near 94%, and it was not independently associated with infection (aOR 1.9 [0.9-4.4], p=0.1). CRE extra-rectal colonization was an independent predictor of any CRE infection (aOR 3.4 [1.4-7.9] p<0.01) and bacteremia (aOR 3.3 [1.3-8.9] p<0.05), with specificity >93% but sensitivity ≈ 20%. Conclusions: In this mixed KPC and NDM CRE setting, weekly rectal surveillance was not a predictor of later infection, while extra rectal colonization retained independent predictive value for overall infection and for bacteremia. [ABSTRACT FROM AUTHOR]
Abstract (Spanish):	Antecedentes: Las enterobacterias resistentes a carbapenémicos (ERC) causan infecciones de difícil tratamiento. La vigilancia rectal se usa ampliamente para detectar portadores, pero su valor predictivo en entornos donde co-circulan distintos tipos de carbapenemasas es incierto. Evaluamos si la colonización rectal y extra-rectal por ERC predice infección posterior en una unidad de cuidados intensivos (UCI) con circulación concurrente de KPC y NDM. Métodos: Estudio observacional retrospectivo en una UCI de adultos de 60 camas en la provincia de Buenos Aires, Argentina, entre julio de 2016 y septiembre de 2019. Se efectuó vigilancia rectal semanal a todos los pacientes, y se tomaron muestras extra-rectales según indicación clínica. El seguimiento fue de 90 días desde el primer cultivo positivo o desde el ingreso en no portadores. Los desenlaces fueron cualquier infección por ERC y bacteriemia. Estimamos valores predictivos y ajustamos modelos de regresión logística multivariable. Resultados: Incluimos 495 pacientes, mediana de edad 66 años, 58% varones. El 66% presentó colonización rectal y el 8% colonización extra-rectal. La colonización rectal por ERC mostró un valor predictivo positivo bajo para cualquier infección (≈10%), con alto valor predictivo negativo (≈94%), y no se asoció de forma independiente con infección (OR ajustada 1,9; IC 95% 0,9-4,4; p=0,1). La colonización extra-rectal por ERC fue un predictor independiente de cualquier infección por ERC (ORa 3,4; IC 95% 1,4-7,9; p<0,01) y de bacteriemia (ORa 3,3; IC 95% 1,3-8,9; p<0,05), con especificidad >93% pero sensibilidad ≈20%. Conclusiones: En este contexto mixto de ERC KPC y ERC NDM, la vigilancia rectal semanal no predijo la infección posterior, mientras que la colonización extra-rectal mantuvo valor predictivo independiente para infección global y para bacteriemia. [ABSTRACT FROM AUTHOR]
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Database:	MedicLatina

Description
Abstract:	Background: Carbapenem-resistant Enterobacterales (CRE) cause hard-to-treat infections. Rectal surveillance is widely used to detect carriers, but its predictive value where different carbapenemases co-circulate is unclear. We assessed whether CRE rectal and extra-rectal colonization predicts subsequent infection in an intensive care unit with concurrent KPC and NDM circulation. Methods: We performed a retrospective observational study in a 60-bed adult intensive care unit in Buenos Aires, Argentina, from July 2016 to September 2019. All patients underwent weekly rectal surveillance, and extra rectal samples were taken when clinically indicated. Following up lasted 90 days from the first positive culture or from admission for non-carriers. Outcomes were any CRE infection and bacteremia. We estimated predictive values and fitted multivariable logistic regression models. Results: We included 495 patients, median age 66 years, 58% male. Of them, 66% had rectal colonization and 8% had extrarectal colonization. CRE rectal carriage showed low PPV for any infection, about 10%, with high NPV near 94%, and it was not independently associated with infection (aOR 1.9 [0.9-4.4], p=0.1). CRE extra-rectal colonization was an independent predictor of any CRE infection (aOR 3.4 [1.4-7.9] p<0.01) and bacteremia (aOR 3.3 [1.3-8.9] p<0.05), with specificity >93% but sensitivity ≈ 20%. Conclusions: In this mixed KPC and NDM CRE setting, weekly rectal surveillance was not a predictor of later infection, while extra rectal colonization retained independent predictive value for overall infection and for bacteremia. [ABSTRACT FROM AUTHOR]
ISSN:	02143429
DOI:	10.37201/req/113.2025