# Rectal Colonization by Carbapenemase-Producing Enterobacterales in a Tertiary Care Hospital in Havana, Cuba

## TL;DR

This study found that 15.5% of patients in a Cuban hospital were colonized with antibiotic-resistant bacteria, which can lead to serious infections.

## Contribution

The study identifies the prevalence and genetic spread of carbapenemase-producing Enterobacterales in a Cuban hospital setting.

## Key findings

- NDM-producing Klebsiella pneumoniae was the most common carbapenemase-producing bacteria found.
- 17.4% of colonized patients developed infections linked to medical procedures like catheter use and surgery.
- Clonal expansion of the bacteria suggests outbreaks among hospitalized patients.

## Abstract

Introduction: Rectal colonization by carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) is a risk factor for subsequent infections, which are associated with high mortality rates. Methods: A cross-sectional study was conducted. Rectal swabs were collected from 297 patients within 48 h of admission to eight high-prevalence CP-CRE hospital departments, with follow-up swabs taken weekly for up to 4 weeks. Species identification, antimicrobial susceptibility testing, and genetic detection of carbapenemases were performed. The genetic relationship among isolates was assessed using ERIC-PCR, combined with epidemiological data, to investigate subsequent infections. Results: Fecal carriage of CP-CRE was detected in 15.5% (46/297) of patients- All carbapenemases were metallo-betalactamases, with dominance of NDM-producing Klebsiella pneumoniae. NDM + VIM-producing Escherichia coli were also detected. Among carriers, 26.1% were colonized by two different CRE species, and 86.9% had a history of prior hospitalization. Molecular analysis revealed clonal expansion, suggesting outbreaks among colonized patients. Additionally, 17.4% (8/46) of colonized patients developed an infection, which was significantly associated with urinary catheter use (p = 0.040), mechanical ventilation (p = 0.044), and surgical procedures (p = 0.040). Conclusions: rectal colonization by CP-CRE in hospitalized patients is a serious epidemiological concern, with evidence of clonal spread and subsequent infection in colonized patients. NDM-producing K. pneumoniae was also predominant, detecting co-production of NDM + VIM in E. coli. These findings underscore the urgent need to implement epidemiological surveillance cultures to improve the prevention and control of CP-CRE infections in Cuban hospitals.