Carbapenemase-producing carbapenem-resistant Enterobacterales in surgical intensive care unit patients in a tertiary hospital in India.

Hall, Lindsey R; Benedict, Emily E; Edathadathil, Fabia; Jacob, Jobin J; Suresh, Devendhu; Krishna, Yathu; Varghese, Juby A; van Rheenen, Jacaranda et al. · Nat Commun · 2026

prospective_cohort · Level II

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Abstract

Carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) transmission studies incorporating clinical and genomic data from hospitals in India are lacking. We prospectively enrolled surgical intensive care unit (SICU) patients in a tertiary-care hospital in India (July 29 to November 30, 2023) and collected peri-rectal swabs at SICU admission, SICU discharge, and hospital discharge, alongside SICU environmental sampling. CP-CRE isolates were whole-genome sequenced to investigate differences between community-acquired (CA), healthcare-associated (HCA), hospital-acquired (HA), and environmental isolates. Twenty-seven percent of participants were CP-CRE-colonized on SICU admission, with risk factors of previous hospitalization and exposure to ≥2 antimicrobials. Among 148 admission-negative patients, 115 had repeat PRS; 42 (36.5%) acquired CP-CRE (27 upon SICU discharge, 15 upon hospital discharge). bla<sub>NDM</sub> (84%, n = 103) and bla<sub>OXA</sub> (29%, n = 36) carbapenemase genes were present in the sequenced isolates; 20 isolates (16%) carried both. Highly similar E. coli and K. pneumoniae clusters suggest hospital transmission, although the sample size limited network inference.