Rectal Colonization by Carbapenemase-Producing Enterobacterales in a Tertiary Care Hospital in Havana, Cuba

<b>Introduction:</b> Rectal colonization by carbapenemase-producing carbapenem-resistant <i>Enterobacterales</i> (CP-CRE) is a risk factor for subsequent infections, which are associated with high mortality rates. <b>Methods:</b> A cross-sectional study was conducted. Rectal swabs were collected from 297 patients within 48 h of admission to eight high-prevalence CP-CRE hospital departments, with follow-up swabs taken weekly for up to 4 weeks. Species identification, antimicrobial susceptibility testing, and genetic detection of carbapenemases were performed. The genetic relationship among isolates was assessed using ERIC-PCR, combined with epidemiological data, to investigate subsequent infections. <b>Results:</b> Fecal carriage of CP-CRE was detected in 15.5% (46/297) of patients- All carbapenemases were metallo-betalactamases, with dominance of NDM-producing <i>Klebsiella pneumoniae</i>. NDM + VIM-producing <i>Escherichia coli</i> were also detected. Among carriers, 26.1% were colonized by two different CRE species, and 86.9% had a history of prior hospitalization. Molecular analysis revealed clonal expansion, suggesting outbreaks among colonized patients. Additionally, 17.4% (8/46) of colonized patients developed an infection, which was significantly associated with urinary catheter use (<i>p</i> = 0.040), mechanical ventilation (<i>p</i> = 0.044), and surgical procedures (<i>p</i> = 0.040). <b>Conclusions:</b> rectal colonization by CP-CRE in hospitalized patients is a serious epidemiological concern, with evidence of clonal spread and subsequent infection in colonized patients. NDM-producing <i>K. pneumoniae</i> was also predominant, detecting co-production of NDM + VIM in <i>E. coli</i>. These findings underscore the urgent need to implement epidemiological surveillance cultures to improve the prevention and control of CP-CRE infections in Cuban hospitals.