Background

With the increasing use of carbapenems in clinical practice, carbapenem-resistant Enterobacterales (CRE) has also increased, posing a significant threat to human health.

Aim

To assess the effects of CRE colonization active screening and various CRE patient placements implemented in decreasing CRE infection risk.

Methods

CRE colonization screening and various CRE patient placements were performed across CRE high-risk departments (paediatric intensive care unit, neonatal intensive care unit, neonatal wards and haematology departments) between 2017 and 2018.

Findings

In 2018, more than 80% of neonatal CRE-positive patients were isolated using single-room or same-room isolation, and more than 50% of non-neonatal patients were isolated with no cohort placement. The CRE nosocomial infection incidences decreased from 1.96% to 0.63% in the neonatal intensive care unit, and from 0.57% to 0.30% in neonatal wards (all P<0.05) while no significant changes were found in the other departments. The CRE colonization incidence at different lengths of hospital stay (LOSs) decreased at eight to 14 days and >14 days LOS in CRE high-risk departments (all P<0.05). In addition, 62.5% clinical strains, 66.7% screening strains, and 74.1% nosocomial infection strains belonged to the CC17 complex group in neonatal isolates; while, 56.6%, 47.5% and 100% strains mentioned above belonged to the CC11 complex group in non-neonatal isolates. The predominant carbapenemase gene was bla_NDM-1 (98%) in neonatal and bla_KPC-2 (70%) in non-neonatal carbapenem-resistant Klebsiella pneumoniae (CR-KP) stains.

Conclusions

Active CRE colonization surveillance and CRE-positive appropriate patient placement may decrease the CRE infection risk. Neonatal and non-neonatal CR-KP isolates showed different CRE molecular characteristics, which could further benefit CRE infection precaution and antibiotic therapy.