Hospital Practices and Research

Rectal Colonization with Carbapenemase-Producing Enterobacteriaceae in Pre-Operative Patients: Prevalence, Risk Factors, and Surgical Outcomes

Document Type : Original Article

Authors

Shatabdi Das 1
Kumar Vikram 2
Roumi Ghosh 2
Saikat Bhattacharya 3
Nalini Aurora 4

1 Department of General Surgery, Murshidabad Medical College and Hospital, Murshidabad, India

2 Department of Microbiology, ESI – PGIMSR, ESIC Medical College and Hospital, Joka, Kolkata, India

3 Department of Community Medicine, NRS Medical College, Kolkata, India

4 Department of Obstetrics and Gynaecology, ESI – PGIMSR, ESIC Medical College and Hospital, Joka, Kolkata, India

https://doi.org/10.30491/hpr.2025.532923.1497
Abstract
Background: Emergence and dissemination of resistance to carbapenems among carbapenemase-producing Enterobacteriaceae (CPE) has led to limited therapeutic options for patients infected with CPE.
Objectives: This study aimed to determine the prevalence of CPE colonization among newly admitted patients scheduled for surgery, identify the risk factors for acquiring CPE, and assess post-surgical outcomes among CPE carriers.
Methods: A total of 152 patients scheduled for various types of planned surgery were included in the study. Two rectal swabs were collected from each patient and processed following the CDC-recommended method for screening Carbapenem-resistant Enterobacteriaceae (CRE). Probable CRE colonies were then tested using the mCIM for carbapenemase production according to CLSI guidelines. Patients were followed up after two months to monitor for any post-surgical infections. Surveillance swab sampling was conducted to detect the spread of CPE in the hospital environment by CPE carriers.
Results: A high occurrence (15.13%) of CPE colonization was recorded in patients admitted for different planned surgeries. A history of antibiotic therapy was significantly associated with CPE acquisition (P<0.001). A significantly higher proportion of CPE carriers developed post-surgical infections compared to non-carriers (87% vs. 13.1%; P<0.0001). All the patients who developed post-surgical infections with CRE were already harboring CPE in their intestines. On environmental sampling, 15 (65.2%) of the 23 CPE-colonized patients were found to be positive for CPE.
Conclusion: High rates of intestinal carriage of CPE among freshly admitted patients, as detected in our study, pose a risk to individuals for CPE infection, leading to antibiotic therapy, long-term hospital stays, and loss of daily wages. Therefore, infection control policies should be formulated by hospitals to screen for CPE carriage during hospital admission, followed by containment of CPE to prevent transmission.

Keywords

Carbapenem-Resistant Enterobacteriaceae
Carbapenemase-Producing Enterobacteriaceae
Surveillance
CRE Screening
Post-Operative Infection
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