Infection Control / Gram Positive Bacterial Infections / Clostridium Infections · Journal article

Rectal carriage with carbapenem-resistant organisms, vancomycin-resistant enterococci, and Clostridioides difficile: insights from a point-prevalence survey in a high-endemic setting.

Diagnostic Microbiology and Infectious Disease · July 14, 2026

Strong Evidence Why this matters to you Expert discussion

Well-designed and adequately powered for the question it asks.

AI Summary

This point-prevalence survey of 424 inpatients in a Greek high-endemic hospital found rectal carriage of carbapenem-resistant organisms (19.8%), vancomycin-resistant enterococci (35.6%), and asymptomatic Clostridioides difficile (9.9%). Multivariable analysis associated CRO carriage with 2.5-fold higher in-hospital mortality and 9.8-fold higher risk of bloodstream infection; both CRO and VRE carriage were independently associated with ~21 additional days of hospitalization; asymptomatic C. difficile was associated with 3.8-fold higher mortality.

What was studied

Point-prevalence survey with prospective clinical outcome follow-up. Adult inpatients at a Greek university hospital; no explicit exclusion criteria reported.. Intervention: Rectal carriage screening for CROs, VRE, and C. difficile using molecular and culture methods. Compared with: Null (observational; no comparator group). n = 424. Single centre: Greek university hospital.

Key findings

CRO rectal carriage prevalence 19.8% (predominantly Enterobacterales 13.4%, P. aeruginosa 6.1%, A. baumannii 5.4%); KPC and NDM carbapenemases most common VRE rectal carriage prevalence 35.6%, almost exclusively E. faecium with VanA phenotype Asymptomatic C. difficile rectal carriage prevalence 9.9%

Safety

CRO carriage associated with in-hospital mortality OR 2.50 (95% CI 1.22–5.11) and CRO bloodstream infection OR 9.77 (95% CI 1.60–58.03) Asymptomatic C. difficile carriage associated with in-hospital mortality OR 3.77 (95% CI 1.40–10.17)

Who this may help

Clinicians in high-endemic settings should recognize that rectal carriage of CROs, VRE, and asymptomatic C. difficile is common (≥10–36%) and independently associated with poor outcomes including mortality and prolonged stay, supporting the case for targeted surveillance and antimicrobial stewardship to reduce transmission and adverse events.

Plain-language summary

Rigorous point-prevalence survey with molecular and culture confirmation, multivariable regression analysis, and clinical outcome follow-up in a defined high-endemic population, establishing significant associations between rectal carriage and mortality/morbidity with reported effect sizes and confidence intervals.

Study design

As stated by the source record.

MethodsOn a single day in October 2024, rectal swabs were obtained from 424 adult inpatients and screened for CROs, VRE, and C. difficile using molecular and culture methods. Participants were followed until hospital discharge or death to ascertain clinical outcomes (hospitalization duration, in-hospital mortality, bloodstream infection). Associations between carriage and outcomes were evaluated using multivariable regression.

DesignPoint-prevalence survey with prospective clinical outcome follow-up

PopulationAdult inpatients at a Greek university hospital; no explicit exclusion criteria reported.

Sample size424

InterventionRectal carriage screening for CROs, VRE, and C. difficile using molecular and culture methods

ComparatorNull (observational; no comparator group)

SettingSingle centre: Greek university hospital

Reported figures

Quoted from the source exactly as published.

CRO carriage prevalence19.8%

VRE carriage prevalence35.6%

Asymptomatic C. difficile carriage prevalence9.9%

CRO-associated in-hospital mortality2.50

CRO-associated in-hospital mortality 95% CI1.22–5.11

CRO bloodstream infection OR9.77

CRO bloodstream infection 95% CI1.60–58.03

CRO carriage: prolonged hospitalization (days)21.52

Clinical bottom line

Caveats

Single-centre study in Greece; generalizability to other settings or low-endemic regions uncertain.
Point-prevalence design precludes causal inference; carriage may reflect rather than cause worse outcomes.
Follow-up duration from swab to discharge/death not specified; outcome ascertainment window unclear.
No comparison group; multivariable regression does not control for unmeasured confounders (e.g., severity of illness at baseline, reason for hospitalization).

Evidence assessment

Graded across the dimensions that decide whether you should act, each from what the source actually supports. There is no single score, and where a dimension was not assessed it says so.

Study design

strong

Prospective point-prevalence survey with systematic screening and clinical outcome ascertainment.

Directness

strong

Rectal carriage measured directly via molecular and culture methods; clinical outcomes (mortality, BSI, LOS) recorded prospectively.

Consistency

moderate

Single centre; findings consistent with known epidemiology of high-endemic settings but external replication needed.

Risk of bias

moderate

Point-prevalence design limits causal inference; no comparison group; outcome follow-up duration not specified.

Sample adequacy

strong

424 adult inpatients enrolled; prevalence estimates precise; multivariable regression conducted with adequate denominators.

Source abstract

Background. Rectal carriage of multidrug-resistant organisms (MDROs) and Clostridioides difficile contributes to hospital transmission, yet data from high-endemic settings remain limited.Methods. We conducted a point-prevalence survey in October 2024 among 424 adult inpatients at a Greek university hospital. Rectal swabs were screened for carbapenem-resistant organisms (CROs), vancomycin-resistant enterococci (VRE), and C. difficile using molecular and culture methods. Participants were followed until discharge or death to assess clinical outcomes. Associations were evaluated using multivariable regression.Results. Prevalence was 19.8% for CROs, 35.6% for VRE, and 9.9% for asymptomatic C. difficile. Among CRO carriers, Enterobacterales predominated (13.4%), followed by Pseudomonas aeruginosa (6.1%) and Acinetobacter baumannii (5.4%), with KPC- and NDM-type carbapenemases most frequently detected. Twenty patients carried multiple carbapenemase genes. VRE isolates were almost exclusively Enterococcus faecium with VanA phenotype. CRO and VRE carriage were associated with prolonged hospitalization (CRO: β-coef: 21.52 days, 95% CI: 8.82-34.22; VRE: β-coef: 21.37, 95% CI: 10.57-32.18). CRO carriage was associated with higher in-hospital mortality (OR: 2.50, 95% CI: 1.22-5.11) and CRO bloodstream infection (OR: 9.77, 95% CI: 1.60-58.03). Asymptomatic C. difficile carriage was linked to higher in-hospital mortality (OR: 3.77, 95% CI: 1.40-10.17).Conclusions. Rectal MDRO and C. difficile carriage is common in high-endemic hospital settings and associated with adverse clinical outcomes, highlighting the need for targeted surveillance, infection control, and antimicrobial stewardship.

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Sofia DamianidouInfection ControlSpyros PournarasGram Positive Bacterial InfectionsPanagiota Christina GeorgiouPolyxeni KarakostaEleni KalogeropoulouAlexandra VasilakopoulouClostridium Infections