Abstract
OBJECTIVE: To characterize the clinical and microbiological features of carbapenem-resistant Enterobacterales (CRE) compared to carbapenem-susceptible Enterobacterales (CSE) in the Dominican Republic (DR), and to assess risk factors associated with CRE. DESIGN: Retrospective case-control study. SETTING: Hospital General Plaza de la Salud, a tertiary teaching hospital in Santo Domingo, DR, from January 2015 to June 2024. PATIENTS: Patients with CRE infections were identified from microbiology records. For each year, a matched group of CSE cases was selected at a 2.5:1 ratio. A total of 101 CRE cases and 280 CSE cases were included. METHODS: Data were collected on demographics, comorbidities, infection sources, hospital stay duration, antibiotic use, and microbiology results. Statistical analysis included univariate and multivariate logistic regression to identify independent risk factors for CRE. RESULTS: CRE cases showed higher prevalence of Enterobacter (36.5%) and Klebsiella (38.5%), while Escherichia predominated in CSE (65.5%). CRE patients had longer hospital stays (mean 18.7 vs 4.6 days, P < 0.001), higher ICU admission rates (34.7% vs 3.6%, P < 0.001), and increased invasive procedure use (eg central venous catheters, 36.6% vs 5.4%, P < 0.001). Key risk factors included antibiotic use (OR 3.09, P < 0.001) and ICU stay (OR 3.60, P= 0.012). The peak CRE resistance rate was 3.47% in 2022, a 64% increase from pre-pandemic levels. CONCLUSIONS: CRE infections in the DR increased during the COVID-19 pandemic, associated with prolonged hospitalizations and critical care. Enhanced antimicrobial stewardship is essential to curb resistance.