Dynamics of Gastrointestinal Colonization with Carbapenem-Resistant Enterobacterales among Critically Ill Patients: A Prospective Study from a Tertiary Care Centre of Western Maharashtra, India
DOI:
https://doi.org/10.21276/apalm.4000Keywords:
enterobacterales, carbapenem-resistant enterobacterales, gut colonization, ICU patientsAbstract
Background: Carbapenem-resistant Enterobacterales (CRE) are among the critical priority pathogens as per World Health Organization and are associated with nearly 40% of ICU-acquired infections. Rectal colonization with CRE is an important risk factor for subsequent invasive infection, particularly in critically ill patients. This study aimed to determine the prevalence of CRE gut colonization among ICU patients at admission and after 7–10 days of hospitalization.
Methods: A prospective longitudinal study was conducted at a tertiary care hospital in Western Maharashtra (Pune) from August 2021 to Dec 2022. All adult ICU patients were included except paediatric patients. Rectal swabs were collected within 24 hours of admission and again after 7–10 days of hospitalization. Samples were inoculated on plain MacConkey agar and Meropenem supplemented MacConkey agar (1 μg/ml meropenem) and incubated at 37°C for 16–18 hours. CRE isolates were identified either by conventional or automated methods, and antimicrobial susceptibility testing was performed according to CLSI guidelines.
Result: A total of 400 patients were included, with 69% aged above 50 years and male predominance. CRE colonization was observed in 19.5% patients on admission, increasing to 22.56% after 7–10 days of hospitalization. Escherichia coli was the predominant CRE isolate on admission (16.57%), whereas Klebsiella pneumoniae became predominant during follow-up (22.15%). Proteus vulgaris showed the highest proportional increase in carbapenem resistance during hospitalization of 7–10 days.
Conclusion: High CRE colonization rates among ICU patients highlight the importance of admission screening, infection control measures, and antimicrobial stewardship to prevent nosocomial transmission and guide targeted therapy.
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