Individualized active surveillance for carbapenem-resistant microorganisms using Xpert Carba-R in intensive care units: A single center, before-after study

Abstract

Background Carbapenem antibiotics are widely used in intensive care units (ICU), and the prevalence of carbapenem-resistant microorganisms (CRO) has increased, forming a major threat to inpatients that urgently requires improved surveillance. This study aimed to assess the role of individualized active surveillance of carbapenem resistance genes on CRO risk. Methods A total of 3,765 patients were admitted to the ICU of Zhongnan Hospital of Wuhan University between 2020 and 2022 (March 2020 to February 2021 in the first period and March 2021 to February 2022 in the second period). The presence of carbapenem resistance genes were monitored using Xpert Carba-R, and CRO incidence was assigned as the investigated outcome. Results Of 3,765 patients, 390 manifested the presence of CRO, representing a prevalence of 10.36%. Active surveillance was associated with a lower CRO risk (odds ratio [OR]: 0.77; 95% confidence interval [CI]: 0.62–0.95; P = 0.013), especially for carbapenem-resistant Acinetobacter + carbapenem-resistant Pseudomonas aeruginosa (OR: 0.79; 95%CI: 0.62–0.99; P = 0.043), carbapenem-resistant Klebsiella pneumoniae (OR: 0.56; 95%CI: 0.40–0.79; P = 0.001), and carbapenem-resistant Enterobacteriaceae (OR: 0.65; 95%CI: 0.47–0.90; P = 0.008). However, active surveillance was not associated with risk of carbapenem-resistant Acinetobacter (P = 0.140), carbapenem-resistant Pseudomonas aeruginosa (P = 0.161), carbapenem-resistant Enterobacteriaceae (except CRKP) (P = 0.259), or ICU stay (P = 0.743). Moreover, there were significant differences between positive and negative active surveillance in high-risk patients with a CRO-positive culture (P < 0.001) or microorganism-positive culture (P < 0.001), time between ICU admission and CRO positivity (P < 0.001), length of hospital stay before surveillance (P = 0.002), carbapenem antibiotic use in the 90 days before surveillance (P = 0.001), corticosteroid use in the 90 days prior to surveillance (P = 0.028), and surgery in the 90 days before surveillance (P = 0.003). Conclusions Individualized active surveillance using Xpert Carba-R may be associated with a reduction in the overall CRO incidence in the ICU, especially for carbapenem-resistant Acinetobacter + carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Klebsiella pneumoniae, and carbapenem-resistant Enterobacteriaceae. Further prospective studies should be performed to verify these conclusions and guide further management of patients in the ICU.