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

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.