Risk factors associated with carbapenem-resistant Enterobacterales infections in hospitalized patients: A case-control study.

Background Carbapenem-Resistant Enterobacterales (CRE) represent a critical public health threat. Aim: To analyze risk factors for CRE infections in adults at a secondary hospital in Manta, Ecuador, during 2022.

Methodology A case-control study (27 cases; 193 controls) compared CRE versus Carbapenem-Susceptible Enterobacterales (CSE). Univariable and Multivariable Firth logistic regression was performed to adjust for small-sample bias.

Results In multivariable analysis, time to infection onset was the most consistent predictor of CRE (aOR: 1.08; 95% CI: 1.03-1.12; p=0.001). Other significant risk factors included chronic corticosteroid therapy (aOR: 43.10; 95% CI: 3.04-611.96; p=0.005), prior hospitalization (aOR: 14.52; 95% CI: 2.22-94.86; p=0.005), urinary catheter (aOR: 10.39; 95% CI: 2.20-49.00; p=0.003) and central venous catheterization (aOR: 13.46; 95% CI: 1.29-139.45; p=0.029). Nosocomial origin (aOR: 0.05; 95% CI: 0.003-0.86; p=0.039), and Internal Medicine management (aOR: 0.23; 95% CI: 0.06-0.94; p=0.041) showed protective associations.

Conclusions In this setting, the cumulative duration of healthcare exposure (time to infection onset) was the primary driver of CRE risk. However, these risk factors are highly context-dependent and vary across different populations and facilities. Therefore, these results cannot be generalized, highlighting the need for localized surveillance and further multicenter studies to understand regional resistance dynamics.