Epidemiology, Clinical Characteristics, and Outcomes of Carbapenem-Resistant Enterobacterales in a Specialist Hospital in Sabah, Malaysia: A Retrospective Cohort Study
DOI:
https://doi.org/10.70672/ma5zcr76Keywords:
Carbapenem-resistant Enterobacterales, CRE colonization, CRE infection, Antimicrobial stewardship, Infection prevention and controlAbstract
Introduction: Carbapenem-resistant Enterobacterales (CRE) represent a growing global health threat associated with high mortality, limited treatment options, and substantial healthcare burden. In Malaysia, increasing carbapenem resistance among Enterobacterales has raised concerns, yet data from East Malaysia remain scarce. This study aimed to describe the epidemiology, clinical characteristics, microbiological profiles, and outcomes of patients with CRE in a major referral hospital in Sabah, Malaysia, and to identify factors associated with CRE infection. Methods: We conducted a single-centre retrospective cohort study at Hospital Queen Elizabeth II involving adult patients with at least one CRE-positive culture between January 2020 and December 2021. CRE was defined according to CDC criteria. Patients were classified as having CRE infection or colonisation based on clinical and laboratory findings. Demographic data, healthcare exposures, antimicrobial use, microbiological characteristics, and outcomes were extracted from medical records. The primary outcome was 30-day all-cause in-hospital mortality. Results: A total of 101 patients were included, of whom 40 (39.6%) had CRE infection and 61 (60.4%) had CRE colonisation. The median time to CRE detection was approximately two weeks of hospitalization. Klebsiella pneumoniae was the predominant organism (68.3%), with New Delhi metallo-β-lactamase (NDM) identified in 79.2% of isolates. Prior exposure to broad-spectrum antibiotics, invasive devices, ICU admission, and recent surgery were common. Thirty-day in-hospital mortality was significantly higher among patients with CRE infection compared with colonisation (52.5% vs 21.3%). Higher Charlson comorbidity index was associated with mortality, while delays in CRE identification were frequently observed. Conclusion: CRE colonisation and infection impose a substantial clinical burden in this tertiary hospital, with high mortality among infected patients and limited therapeutic options. Strengthened infection prevention measures, targeted surveillance, optimized antimicrobial stewardship, and improved access to effective anti-CRE therapies are urgently needed to mitigate CRE transmission and improve patient outcomes.
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