A study in Saudi Arabia indicates that being colonized with a multidrug-resistant organism (MDRO) is associated with a significantly increased risk of subsequent MDRO infection, researchers reported this week in Infection Control & Hospital Epidemiology.
The study, conducted at a tertiary care facility in Riyadh, included patients in active surveillance testing (AST) for carbapenem-resistant Enterobacterales (CRE), methicillin-resistant Staphylococcus aureus (MRSA), or vancomycin-resistant enterococci (VRE). Researchers at the hospital compared the risk of developing a relevant invasive infection within 365 days of the AST result between colonized and non-colonized groups.
While previous studies have documented the link between MDRO colonization and increased risk of subsequent infection, the authors of the study note that little is known about the extent of MDRO colonization in Saudi Arabia's hospitals.
VRE-colonized patients 22% more likely to develop VRE infection
A total of 19,134 ASTs conducted in 2021 were included in the analysis—4,919 for CRE, 8,303 for MRSA, and 5,912 for VRE. Nine percent of patients screened for CRE were colonized, compared with 10% for MRSA and 14% for VRE. Patient demographics were similar between colonized and non-colonized groups.
Compared with the non-colonized group, patients colonized with CRE were 4.6 times (95% confidence interval [CI], 3.3 to 6.4) more likely to develop a CRE infection, with 88% of CRE-colonized patients developing an infection with the same carbapenemase gene. MRSA-colonized patients were 8.2 times (95% CI, 4.7 to 14.3) more likely to develop a MRSA infection than non-colonized patients, and VRE-colonized patients were 22 times (95% CI, 10.1 to 48.1) more likely to develop a VRE infection.
The median time from AST to clinical infection was reduced for patients colonized with CRE and VRE, while MRSA-colonized patients took longer to develop a clinical MRSA infection compared with non-colonized patients.
The authors say the findings highlight the need to implement AST for MDRO colonization and rigorous infection control measures to effectively mitigate transmission of these dangerous pathogens.