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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]
Copyright of Revista Española de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: 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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  Data: Rendimiento predictivo de los cultivos de vigilancia rectal semanales y de la colonizaci&#243;n extra-rectal para infecciones por enterobacterias resistentes a carbapen&#233;micos en una UCI con co-circulaci&#243;n de KPC y NDM en un entorno con recursos limitados
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  Data: &lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Favier%2C+Patricio%22&quot;&gt;Favier, Patricio&lt;/searchLink&gt;&lt;relatesTo&gt;1&lt;/relatesTo&gt;&lt;i&gt; patriciofavier@hotmail.com&lt;/i&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Su&#225;rez-Urquiza%2C+Pedro%22&quot;&gt;Su&#225;rez-Urquiza, Pedro&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Raffo%2C+Carla%22&quot;&gt;Raffo, Carla&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Torres%2C+Diego%22&quot;&gt;Torres, Diego&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Kumar%2C+Liliana%22&quot;&gt;Kumar, Liliana&lt;/searchLink&gt;&lt;relatesTo&gt;4&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22P&#233;rez%2C+Johanna%22&quot;&gt;P&#233;rez, Johanna&lt;/searchLink&gt;&lt;relatesTo&gt;5&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Primost%2C+Ivana%22&quot;&gt;Primost, Ivana&lt;/searchLink&gt;&lt;relatesTo&gt;6&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22In&#233;s+Gallino%2C+Mar&#237;a%22&quot;&gt;In&#233;s Gallino, Mar&#237;a&lt;/searchLink&gt;&lt;relatesTo&gt;6&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Pinilla-Huayta%2C+Fidel%22&quot;&gt;Pinilla-Huayta, Fidel&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Mu&#241;oz-Soto%2C+Claudia%22&quot;&gt;Mu&#241;oz-Soto, Claudia&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Ravelli%2C+Mat&#237;as%22&quot;&gt;Ravelli, Mat&#237;as&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Serio%2C+Enrique%22&quot;&gt;Serio, Enrique&lt;/searchLink&gt;&lt;relatesTo&gt;3&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Pem&#225;n-Garc&#237;a%2C+Javier%22&quot;&gt;Pem&#225;n-Garc&#237;a, Javier&lt;/searchLink&gt;&lt;relatesTo&gt;7&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Valent&#237;n-Mart&#237;n%2C+Amparo%22&quot;&gt;Valent&#237;n-Mart&#237;n, Amparo&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;AR&quot; term=&quot;%22Mar&#237;a+Gonz&#225;lez-Barber&#225;%2C+Eva%22&quot;&gt;Mar&#237;a Gonz&#225;lez-Barber&#225;, Eva&lt;/searchLink&gt;&lt;relatesTo&gt;2&lt;/relatesTo&gt;
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  Data: &lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22CARBAPENEM-resistant+bacteria%22&quot;&gt;CARBAPENEM-resistant bacteria&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22COLONIZATION+%28Ecology%29%22&quot;&gt;COLONIZATION (Ecology)&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22INTENSIVE+care+units%22&quot;&gt;INTENSIVE care units&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22PREDICTIVE+validity%22&quot;&gt;PREDICTIVE validity&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22CARBAPENEMASE%22&quot;&gt;CARBAPENEMASE&lt;/searchLink&gt;&lt;br /&gt;&lt;searchLink fieldCode=&quot;DE&quot; term=&quot;%22BACTEREMIA%22&quot;&gt;BACTEREMIA&lt;/searchLink&gt;
– Name: Abstract
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  Data: 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&lt;0.01) and bacteremia (aOR 3.3 [1.3-8.9] p&lt;0.05), with specificity &gt;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]
– Name: Abstract
  Label: Abstract (Spanish)
  Group: Ab
  Data: Antecedentes: Las enterobacterias resistentes a carbapen&#233;micos (ERC) causan infecciones de dif&#237;cil 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 colonizaci&#243;n rectal y extra-rectal por ERC predice infecci&#243;n posterior en una unidad de cuidados intensivos (UCI) con circulaci&#243;n concurrente de KPC y NDM. M&#233;todos: 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 efectu&#243; vigilancia rectal semanal a todos los pacientes, y se tomaron muestras extra-rectales seg&#250;n indicaci&#243;n cl&#237;nica. El seguimiento fue de 90 d&#237;as desde el primer cultivo positivo o desde el ingreso en no portadores. Los desenlaces fueron cualquier infecci&#243;n por ERC y bacteriemia. Estimamos valores predictivos y ajustamos modelos de regresi&#243;n log&#237;stica multivariable. Resultados: Incluimos 495 pacientes, mediana de edad 66 a&#241;os, 58% varones. El 66% present&#243; colonizaci&#243;n rectal y el 8% colonizaci&#243;n extra-rectal. La colonizaci&#243;n rectal por ERC mostr&#243; un valor predictivo positivo bajo para cualquier infecci&#243;n (≈10%), con alto valor predictivo negativo (≈94%), y no se asoci&#243; de forma independiente con infecci&#243;n (OR ajustada 1,9; IC 95% 0,9-4,4; p=0,1). La colonizaci&#243;n extra-rectal por ERC fue un predictor independiente de cualquier infecci&#243;n por ERC (ORa 3,4; IC 95% 1,4-7,9; p&lt;0,01) y de bacteriemia (ORa 3,3; IC 95% 1,3-8,9; p&lt;0,05), con especificidad &gt;93% pero sensibilidad ≈20%. Conclusiones: En este contexto mixto de ERC KPC y ERC NDM, la vigilancia rectal semanal no predijo la infecci&#243;n posterior, mientras que la colonizaci&#243;n extra-rectal mantuvo valor predictivo independiente para infecci&#243;n global y para bacteriemia. [ABSTRACT FROM AUTHOR]
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  Data: &lt;i&gt;Copyright of Revista Espa&#241;ola de Quimioterapia is the property of Sociedad Espanola de Quimioterapia and its content may not be copied or emailed to multiple sites without the copyright holder&#39;s express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.&lt;/i&gt; (Copyright applies to all Abstracts.)
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        Value: 10.37201/req/113.2025
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        Text: English
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      – SubjectFull: COLONIZATION (Ecology)
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