{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T18:02:41Z","timestamp":1790618561339,"version":"4.1.0"},"reference-count":22,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003052","name":"Ministry of Trade, Industry and Energy","doi-asserted-by":"publisher","award":["RS 2024-00403563"],"award-info":[{"award-number":["RS 2024-00403563"]}],"id":[{"id":"10.13039\/501100003052","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Carbapenem-resistant Enterobacterales (CRE) represent a critical threat to patient safety, particularly in long-term care hospitals (LTCHs) where elderly patients with multiple comorbidities are concentrated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To analyze asymptomatic CRE colonization, acquisition and risk factors in LTCHs prospectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A prospective active surveillance study was conducted on 140 patients across four LTCHs in Korea from November 2023 to December 2024. Rectal swab cultures were performed weekly for up to six weeks and at three months to isolate CRE. Prevalence, acquisition rate, time to detection, and risk factors for CRE colonization were analyzed. Kaplan\u2013Meier curves were used to compare acquisition patterns according to patient type, and Cox proportional-hazard models were applied to identify risk factors among patients who were CRE-negative at baseline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The overall prevalence of asymptomatic CRE colonization was 24.3% (34\/140). The colonization rate was higher among newly admitted patients (30.8%) compared to current inpatients (21.8%). Carbapenemase-producing Enterobacterales (CPE) accounted for 80.0% of CRE isolates, with KPC being predominant. Among initially negative patients, 8.6% acquired CRE during hospitalization. Kaplan\u2013Meier analysis revealed a dynamic pattern: current inpatients showed higher acquisition rates early on, while newly admitted patients showed higher cumulative rates after three weeks. Key risk factors included invasive device use within the past year (hazard ratio, HR: 9.83) and prior room sharing with CRE patients (HR: 5.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LTCHs serve as favorable environments for both CRE importation and intra-facility transmission. Strict adherence to standard precautions, targeted screening of high-risk individuals, and prompt cohorting or isolation of CRE-positive patients are essential for effective control. These findings provide prospective evidence supporting strengthened surveillance and infection prevention strategies in long-term care settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0358973","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:37:13Z","timestamp":1790617033000},"page":"e0358973","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence, acquisition, and risk factors of carbapenem-resistant enterobacterales colonization in long-term care hospitals: A prospective active surveillance study"],"prefix":"10.1371","volume":"21","author":[{"given":"Hyejin","family":"Hwang","sequence":"first","affiliation":[{"name":"Gyeongsangnam-do Center for Infectious Disease Control and Prevention","place":["Changwon, Republic of Korea"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8099-8891","authenticated-orcid":true,"given":"Sunjoo","family":"Kim","sequence":"additional","affiliation":[{"name":"Gyeongsangnam-do Center for Infectious Disease Control and Prevention","place":["Changwon, Republic of Korea"]},{"name":"GC Labs","place":["Yangsan, Republic of Korea"],"department":["Department of Laboratory Medicine"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"pone.0358973.ref001","doi-asserted-by":"crossref","first-page":"601968","DOI":"10.3389\/fcimb.2021.601968","article-title":"Carbapenem-resistant Enterobacterales in long-term care facilitieis: a global and narrative review","volume":"11","author":"H-Y Chen","year":"2021","journal-title":"Front Cell Infect Microbiol"},{"key":"pone.0358973.ref002","volume-title":"Carbapenem-resistant Enterobacterales, third update","author":"European Centre for Disease Prevention and Control","year":"2025"},{"key":"pone.0358973.ref003","volume-title":"Guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii and Pseudomonas aeruginosa in health-care facilities","author":"World Health Organization","year":"2017"},{"issue":"8","key":"pone.0358973.ref004","doi-asserted-by":"crossref","first-page":"1286","DOI":"10.3390\/antibiotics12081286","article-title":"Epidemiology of carbapenem-resistant Enterobacteriaceae bacteremia in Gyeonggi Province. Republic of Korea, between 2018 and 2021","volume":"12","author":"SH Lee","year":"2023","journal-title":"Antibiotics (Basel)"},{"key":"pone.0358973.ref005","volume-title":"Prevention, control, and management of carbapenem-resistant Enterobacteriaceae in long-term care facilities","author":"Illinois Department of Public Health","year":"2016"},{"issue":"1","key":"pone.0358973.ref006","doi-asserted-by":"crossref","first-page":"240","DOI":"10.1186\/s13643-022-02110-3","article-title":"Prevalence and incidence of carbapenem-resistant K. pneumoniae colonization: systematic review and meta-analysis","volume":"11","author":"T Tesfa","year":"2022","journal-title":"Syst Rev"},{"issue":"6","key":"pone.0358973.ref007","doi-asserted-by":"crossref","first-page":"680","DOI":"10.3390\/antibiotics10060680","article-title":"Cisneros JM. Prevalence and risk factors for multidrug-resistant organisms colonization in long-term care facilities around the world: a review","volume":"10","author":"\u00c1 Rodr\u00edguez-Villodres","year":"2021","journal-title":"Antibiotics (Basel)"},{"issue":"2","key":"pone.0358973.ref008","first-page":"75","article-title":"Characteristics of notified carbapenem-resistant Enterobacterlaes cases in the Republic of Korea, 2023","volume":"18","author":"H Lee","year":"2025","journal-title":"Jugan Geongang Gwa Jilbyeong"},{"key":"pone.0358973.ref009","volume-title":"2024 Guidelines for control of healthcare-associated infection","author":"Korea Disease Control and Prevention Agency","year":"2024"},{"issue":"36","key":"pone.0358973.ref010","article-title":"Positivity of carbapenemase-producing Enterobacteriaceae in patients following exposure within long-term care facilities in Seoul, Korea","volume":"35","author":"JJ Park","year":"2020","journal-title":"J Korean Med Sci"},{"key":"pone.0358973.ref011","doi-asserted-by":"crossref","DOI":"10.4178\/epih.e2023057","article-title":"Outbreak of carbapenem-resistant Enterobacterales at a long-term care facility in Seoul, Korea: surveillance and intervention mitigation strategies","volume":"45","author":"Y Park","year":"2023","journal-title":"Epidemiol Health"},{"issue":"1","key":"pone.0358973.ref012","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s13756-022-01200-0","article-title":"Risk factors for colonization by carbapenemase-producing bacteria in Spanish long-term care facilities: a multicentre point-prevalence study","volume":"11","author":"M Callej\u00f3n Fern\u00e1ndez","year":"2022","journal-title":"Antimicrob Resist Infect Control"},{"issue":"1","key":"pone.0358973.ref013","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1186\/s12879-024-09307-y","article-title":"A practical approach to screening for carbapenemase-producing Enterobacterales- views of a group of multidisciplinary experts from English hospitals","volume":"24","author":"DR Jenkins","year":"2024","journal-title":"BMC Infect Dis"},{"key":"pone.0358973.ref014","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s13756-017-0259-z","article-title":"Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: guidance from the European Centre for Disease Prevention and Control","volume":"6","author":"AP Magiorakos","year":"2017","journal-title":"Antimicrob Resist Infect Control"},{"issue":"3","key":"pone.0358973.ref015","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.jinf.2018.11.003","article-title":"Whole genome sequencing detects inter-facility transmission of carbapenem-resistant Klebsiella pneumoniae","volume":"78","author":"MD Spencer","year":"2019","journal-title":"J Infect"},{"issue":"18","key":"pone.0358973.ref016","article-title":"Prevalence and risk factors of carbapenem-resistant Enterobacteriaceae acquisition in an emergency intensive care unit in a tertiary hospital in Korea: a case-control study","volume":"34","author":"JS Kang","year":"2019","journal-title":"J Korean Med Sci"},{"issue":"2","key":"pone.0358973.ref017","doi-asserted-by":"crossref","first-page":"183","DOI":"10.3947\/ic.2020.52.2.183","article-title":"Prevalence of multidrug-resistant organisms and risk factors for carriage among patients transferred from long-term care facilities","volume":"52","author":"H Jeong","year":"2020","journal-title":"Infect Chemother"},{"key":"pone.0358973.ref018","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1016\/j.jhin.2025.07.030","article-title":"Prevalence of carbapenem-resistant Enterobacterales in healthcare and community settings in the UK: A systematic review and meta-analysis","volume":"165","author":"H Almadhoon","year":"2025","journal-title":"J Hosp Infect"},{"key":"pone.0358973.ref019","volume-title":"Carbapenem-Resistant Enterobacteriaceae (CRE): November 2015 Update \u2013 CRE Toolkit","author":"Centers for Disease Control and Prevention","year":"2015"},{"issue":"11","key":"pone.0358973.ref020","doi-asserted-by":"crossref","first-page":"1782","DOI":"10.1093\/infdis\/jiz288","article-title":"Knowing more of the iceberg: how detecting a greater proportion of carbapenem-resistant Enterobacteriaceae carriers influences transmission","volume":"221","author":"SM Bartsch","year":"2020","journal-title":"J Infect Dis"},{"issue":"10","key":"pone.0358973.ref021","doi-asserted-by":"crossref","first-page":"1401","DOI":"10.3390\/antibiotics11101401","article-title":"Active surveillance for carbapenem-resistant Enterobacterales (CRE) colonization and clinical course of CRE colonization among hospitalized patients at a university hospital in Thailand","volume":"11","author":"W Wangchinda","year":"2022","journal-title":"Antibiotics (Basel)"},{"issue":"6","key":"pone.0358973.ref022","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1093\/cid\/ciy572","article-title":"Success of a national intervention in controlling carbapenem-resistant Enterobacteriaceae in Israel's long-term care facilities","volume":"68","author":"D Ben-David","year":"2019","journal-title":"Clin Infect Dis"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358973","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T17:37:18Z","timestamp":1790617038000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0358973"}},"subtitle":[],"editor":[{"given":"Iddya","family":"Karunasagar","sequence":"first","affiliation":[{"name":"Nitte University","place":["INDIA"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":22,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,28]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0358973","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]}}}