Background During the last quarter of 2017, there was an increase in the number of patients with carbapenem-resistant Klebsiella pneumoniae (CRKP) in the adult intensive care unit (AICU) at King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia. Worldwide, invasive infections caused by carbapenem-resistant Enterobacteriaceae, including CRKP, have been associated with high morbidity and mortality. The target population at AICU is mainly oncology patients who need critical care. It has been suggested that active surveillance testing (AST) can help to minimize exposure within selected units. Additionally, it can estimate the percentage of within-unit acquisition of CRKP. The objective of the current study was to estimate the acquisition of CRKP and the compliance with AST.

Methods AST was done to all patients admitted to the AICU between January 2018 to December 2018 and to those who were discharged, provided that no positive AST or clinical results were documented at admission or during the unit stay. Acquisition of CRKP was defined as positive CRKP (detected by AST or clinically) after an initial negative finding during the first 3 days of unit stay. Compliance of admission AST was defined as testing rectal specimens obtained during the first 3 days of unit stay among all admitted patients. Compliance of discharge AST was defined as testing rectal specimens obtained at discharge or after the first 3 days of unit stay among non-prevalent patients.

Results During the study period, 375 (90.1%) of 416 admitted patients had AST at admission. Of the 375, 180 (48.0%) were eligible for discharge AST. 87 (48.3%) of the 180 eligible patients had AST at discharge. The prevalence of positive CRKP at admission was 1.9% (seven of 375). Acquisition of CRKP during the unit stay was 3.4% (three of 87). Of 416 patients admitted to the AICU, 30.5% died, 69.0% were transferred to another unit, and 0.5% were discharged.

Conclusion The findings showed high compliance of AST at admission but low compliance at discharge, which needs further enforcement. Although the acquisition of CRKP was only 3.4%, it represents adding almost double (1.8) new cases of CRKP to the admission level. Future research is required to assess the impact of AST on the burden of healthcare-associated infections.