Retrospective cohort reports frequent subsequent CRE infection after rectal colonization in adult ICU patients

A single-center retrospective cohort reported culture-proven carbapenem-resistant Enterobacterales (CRE) infection after rectal CRE colonization in 132 of 271 evaluable adult intensive care unit admissions. The estimated cumulative incidence of subsequent infection was 25.8% at seven days, 36.2% at 14 days and 45.0% at 28 days, according to the study abstract.

The study screened adult ICU patients by rectal culture at admission and weekly from July 2022 through August 2025. Rectal CRE colonization was identified in 287 of 3,221 ICU admissions, or 8.9%. Colonization was present at admission in 88 cases (30.7%) and acquired during the ICU stay in 199 (69.3%). Sixteen infections were detected on the colonization date and evaluated separately, leaving 271 admissions for the primary analysis of infection occurring after colonization.

For the risk analysis, time zero was defined as the first documented CRE colonization date. The researchers used competing-risk methods to estimate cumulative incidence, treating ICU death and live ICU discharge before infection as competing events. No evaluated factor was independently associated with subsequent infection in the Fine-Gray model. Prior colistin exposure was borderline but not statistically significant, with a subdistribution hazard ratio of 1.53, a 95% confidence interval of 0.99–2.37 and p = 0.057.

Mortality was higher among patients who developed subsequent infection than among those who did not: 71.2% versus 55.4% (p = 0.007). This was an observed association in a retrospective cohort and does not establish that subsequent infection caused the higher mortality. The findings are limited by the single-center design, retrospective data and the screened adult ICU population, and the available report is an abstract of an accepted article subject to later revision rather than a full assessment of the study.

Subject of Research: Prevalence, timing, outcomes and risk factors for subsequent CRE infection after rectal colonization in adult ICU patients

Article Title: Rectal colonization with Carbapenem-resistant Enterobacterales in intensive care unit patients: prevalence, clinical outcomes, and risk of subsequent infection

Article References: Yüce Yıldırım, D., Şenol, G., Yiş, R., & Gülfidan, Ö. G. (2026). Rectal colonization with Carbapenem-resistant Enterobacterales in intensive care unit patients: prevalence, clinical outcomes, and risk of subsequent infection. BMC Infectious Diseases. https://doi.org/10.1186/s12879-026-14445-6

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DOI: 10.1186/s12879-026-14445-6

Keywords: CRE colonization, rectal culture, intensive care units, subsequent infection, carbapenem resistance, Enterobacterales, cumulative incidence, Fine-Gray model, retrospective cohort, patient mortality, Rectal, colonization