产生碳青霉烯酶的肠杆菌（CPE）是全球感染控制领域关注的问题，尽管加强了接触预防措施，但医院内的 CPE 暴发数量仍在增加。本研究旨在通过粪便监测培养确认 CPE 感染的患病率和转移率，并确定 CPE 的获得途径。这是自 2018 年 7 月起对韩国首尔一家三级中心进行粪便监测培养的患者进行的纵向回顾至2020年6月，对产碳青霉烯酶肺炎克雷伯菌和大肠杆菌菌株进行脉冲场凝胶电泳、多位点序列分型和全基因组测序。在1620名接受过粪便CPE监测培养的患者中，只有7.1%的主动监测在急诊室 (ER) 和重症监护病房 (ICU) 的普遍监测中，4.4% 的粪便 CPE 呈阳性。急诊室中粪便携带者向临床 CPE 感染的转变率为 29.4%，ICU 中为 31.3%。然而，在最初粪便 CPE 阴性的 ICU 患者中，这一比例显着较高 (55.0%)。初次粪便 CPE 阳性患者中，高血压（61% vs. 92.3%，P = 0.004）、恶性肿瘤（28.8% vs. 53.8%，P = 0.027）和机械通气（25.4% vs. 53.8%，P = 0.011）是临床CPE感染的显着危险因素。分子分型显示，肺炎克雷伯菌中序列类型（ST）307和ST 395占优势，大肠杆菌分离株中序列类型（ST）410占优势。主动监测的检出率高于普遍粪便CPE筛查，三分之一的阳性率粪便 CPE 标本最终发展为后续的临床 CPE 感染。根据已识别的 CPE 菌株的分子分型，院内传播优于外部流入，并且 ICU 中向临床 CPE 的转化率特别高。因此，为了控制CPE传播，不仅需要主动监测以阻止外部流入，还需要在医院内进行持续的ICU监测。版权所有©2023作者。由爱思唯尔有限公司出版。保留所有权利。

Carbapenemase-producing Enterobacterales (CPE) are global concerns in infection control, and the number of CPE outbreaks in hospitals is increasing despite the strengthening of contact precautions. This study aimed to confirm the prevalence and transition rate of CPE infection from stool surveillance culture and to identify the acquisition pathway of CPE.This is a longitudinal review of patients with stool surveillance cultures at a tertiary center in Seoul, South Korea, from July 2018 to June 2020. Pulsed-field gel electrophoresis, multi-locus sequence typing, and whole genome sequencing were performed for carbapenemase-producing Klebsiella pneumoniae and Escherichia coli strains.Among 1620 patients who had undergone stool CPE surveillance cultures, only 7.1% of active surveillance at the Emergency Room (ER) and 4.4% of universal surveillance in the Intensive Care Unit (ICU) were stool CPE positive. The transition rates from stool carriers to clinical CPE infections were 29.4% in the ER and 31.3% in the ICU. However, it was significantly high (55.0%) in the initial stool CPE-negative ICU patients. Among the initial stool CPE-positive patients, hypertension (61% vs. 92.3%, P = 0.004), malignancy (28.8% vs. 53.8%, P = 0.027), and mechanical ventilation (25.4% vs. 53.8%, P = 0.011) were significant risk factors for clinical CPE infection. Molecular typing revealed that sequence type (ST) 307 and ST 395 were dominant in K. pneumoniae, and ST 410 was dominant in E. coli isolates.Active surveillance showed a higher detection rate than universal stool CPE screening, and one-third of positive stool CPE specimens ultimately developed subsquent clinical CPE infection. According to the molecular typing of the identified CPE strains, in-hospital spread prevailed over external inflow, and the transition rate to clinical CPE was particularly high in the ICU. Therefore, in order to control CPE propagation, not only active surveillance to block inflow from outside, but also continuous ICU monitoring within the hospital is necessary.Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.