Distribution and Risk Factors of Carbapenem-Resistant Enterobacterales in General Hospitals in South Korea

Abstract

The emergence of Carbapenem-Resistant Enterobacterales (CRE) presents a significant global health challenge due to its high resistance to broad-spectrum β-lactam antibiotics. CRE infections are increasingly common in hospital settings and are associated with high mortality rates. In South Korea, the increase in CRE infections necessitates a detailed investigation into their distribution and risk factors to inform effective management and prevention strategies. Therefore, the aim of this study was to analyze the distribution of CRE and its major risk factors through surveillance culture tests among high-risk patients at a small general hospital in Asan, South Chungcheong Province, South Korea from February 2023 to mid-May 2024, and compile basic data for managing and preventing CRE infections. Herein, 173 out of the 2,078 high-risk patients were CRE positive, with a positive rate of 8%. Carbapenemase-Producing Enterobacterales (CPE) accounted for 65% of the CRE-positive patients. Among the CRE- or CPE-positive strains, Klebsiella pneumoniae with the KPC gene was the most prevalent. Old age (>70 years, p = 0.015) and history of hospitalization in nursing homes (p = 0.045) or intensive care units (p = 0.002) were significant risk factors for CRE and CPE positivity. Significant age-related differences were observed, with CRE and CPE infections more frequent in patients aged >70 years. The study highlights a high prevalence of CRE and CPE, particularly in older adults, those transferred to nursing homes, and those with a history of admission to intensive care units. They should be closely monitored for underlying diseases, previous bacterial culture results, and use of invasive devices. To reduce CRE and CPE infections, rapid CPE gene detection and expanded surveillance culture targets are recommended, especially in high-risk settings, such as intensive care units and long-term care facilities.