Hospital-acquired infections with carbapenem-resistant Enterobacterales (CRE) present a significant challenge in modern clinical medicine. To address this, a recent prospective cohort study has introduced a nomogram specifically designed to predict the CRE secondary infection risk among hospitalized patients already colonized by these organisms. Because India faces a high burden of antimicrobial resistance (AMR), identifying which colonized patients will progress to clinical infection is vital for infection control teams and clinicians. Researchers conducted a large-scale, unbiased active screening of over 9,000 subjects to determine colonization rates and subsequent clinical outcomes.

Identifying Independent Factors for CRE Secondary Infection Risk

Consequently, the investigators found an overall intestinal CRE colonization rate of 4.95%. Among colonized inpatients, the team identified that 5.04% eventually developed a secondary infection. Notably, the risk was not uniform across the hospital. Specifically, the Rehabilitation, ICU, and Neurology departments exhibited the highest infection rates. Furthermore, the multivariate analysis pinpointed several independent risk factors. These include staying in the ICU for 48 hours or more, prior carbapenem exposure, fecal incontinence, and tracheostomy. Conversely, admission to the Rehabilitation department appeared to be a protective factor in this specific cohort.

Moreover, molecular analysis highlighted the dominance of the ST11 CRKP clone, which accounted for 70% of isolates. Resultantly, the study found that 12 out of 18 secondary infections were genetically homologous to the patient's own colonizing strain. Therefore, the gut serves as a critical reservoir for subsequent infection. Although the nomogram showed excellent predictive power with an Area Under the Curve (AUC) of 0.960, the authors recommend external validation before broad clinical use. Ultimately, this tool empowers physicians to prioritize high-risk patients for enhanced surveillance and stricter antimicrobial stewardship.

Frequently Asked Questions

What is the most common CRE strain found in colonized patients?

Escherichia coli (49.05%) and Klebsiella pneumoniae (46.95%) were the dominant species identified in colonized individuals. However, ST11 CRKP was the most prevalent clone associated with subsequent infections.

Which hospital departments show the highest rates of secondary CRE infections?

The highest secondary infection rates occurred in the Rehabilitation (30%), ICU (21.88%), and Neurology (20%) departments. This underscores the need for targeted screening in these high-risk areas.

How accurate is the new nomogram for risk prediction?

The nomogram demonstrated high discriminative ability with an AUC of 0.960. While effective in the derivation cohort, clinicians should wait for external validation before routine application.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or establish a doctor-patient relationship. Always seek the advice of a qualified healthcare provider regarding any medical condition or treatment. Refer to the latest local and national guidelines for clinical practice.

References

Xie X et al. A nomogram for assessing secondary infection risk in hospitalized patients with intestinal CRE colonization: a prospective cohort study. Ann Clin Microbiol Antimicrob. 2026 May 29. doi: 10.1186/s12941-026-00867-2. PMID: 42216218.

Zheng G et al. Development of a risk prediction model for subsequent infection after colonization with carbapenem-resistant Enterobacterales: a retrospective cohort study. Antimicrob Resist Infect Control. 2024;13(1):46. doi: 10.1186/s13756-024-01394-5.

Shoala ARE-K et al. Clinical Predispositions, Features, and Outcomes of Infections with Carbapenem-resistant Enterobacterales among Critical Care Patients. Indian J Crit Care Med. 2024;29(1):36-44. doi: 10.5005/jp-journals-10071-24876.

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