Rectal colonization with multidrug-resistant organisms and risk for bloodstream infection among high-risk Greek patients

Polyxeni Karakosta; Georgios Meletis; Elisavet Kousouli; Efthymia Protonotariou; Aikaterini Tarpatzi; Sophia Vourli; Panagiota Christina Georgiou; Vasiliki Mamali; Lemonia Skoura; Olympia Zarkotou; Spyros Pournaras

doi:10.1007/s10096-024-04987-5

Rectal colonization with multidrug-resistant organisms and risk for bloodstream infection among high-risk Greek patients

Eur J Clin Microbiol Infect Dis. 2024 Nov 21. doi: 10.1007/s10096-024-04987-5. Online ahead of print.

Affiliations

¹ Laboratory of Clinical Microbiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
² Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece.
³ Department of Microbiology, Tzaneio General Hospital of Piraeus, Piraeus, Greece.
⁴ Institute of Biosciences and Applications, National Centre for Scientific Research "Demokritos", Athens, Greece.
⁵ Laboratory of Clinical Microbiology, School of Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece. [email protected].

PMID: 39572409
DOI: 10.1007/s10096-024-04987-5

Abstract

Background: Studies link multidrug-resistant organism (MDRO) rectal colonization to increased infection risk, data from Greece, a country with high rates of MDRO, are limited.

Methods: We assessed bloodstream infection (BSI) risk following rectal colonization by MDROs across three Greek hospitals (2019-2022).

Results: Of 4,370 inpatients, 31.1% were colonized by carbapenem-resistant Enterobacterales (CRE), 30.1% carbapenem-resistant Acinetobacter baumannii (CRAB), 5.8% carbapenem-resistant Pseudomonas aeruginosa (CRPA), 28.4% vancomycin-resistant enterococci (VRE). Subsequent BSI from the same MDRO species was developed in 15.6% of CRE, 19.7% of CRAB, 9.2% of CRPA and 3.5% of VRE carriers. Previous rectal colonization increases significantly MDRO BSI risk [RR (95%CI): CRE 5.2 (3.9-6.8), CRAB 2.7 (2.2-3.3), CRPA 9.6 (5.8-16.0), VRE 2.5 (1.5-4.2)].

Conclusion: Clinicians should consider MDRO carriage information for selecting empiric treatment.

Keywords: Bacteremias; Carbapenem-resistant Acinetobacter; Carbapenem-resistant Enterobacterales; Carbapenem-resistant Pseudomonas; Carbapenemase; Surveillance cultures.