1 Vol.:(0123456789) Scientifc Reports | (2021) 11:14757 | https://doi.org/10.1038/s41598-021-94295-1 www.nature.com/scientificreports Epidemiology, risk factors, and prediction score of carbapenem resistance among inpatients colonized or infected with 3rd generation cephalosporin resistant Enterobacterales Rima Moghnieh 1* , Dania Abdallah 2 , Marwa Jadayel 3 , Wael Zorkot 4 , Hassan El Masri 4 , Marie Joe Dib 4 , Tasnim Omar 5 , Loubna Sinno 6 , Rawad Lakkis 7 & Tamima Jisr 8 In this study, we determined the incidence and risk factors of Carbapenem-resistant Enterobacterales (CRE) acquisition in inpatients with 3rd generation cephalosporin-resistant (3GCR) Enterobacterales at a tertiary-care hospital in Lebanon, and suggested a risk prediction score for it. This is a retrospective matched case–control study of inpatients with 3GCR Enterobacterales that are carbapenem resistant (cases) versus those with carbapenem-sensitive isolates (controls). Data analysis was performed on IBM SPSS program, version 23.0 (Armonk, NY, USA: IBM Corp.). Categorical variables were compared between cases and controls through bivariate analysis and those with statistical signifcance (P < 0.05) were included in the forward stepwise multiple logistic regression analysis. To develop the CRE acquisition risk score, variables that maintained statistical signifcance in the multivariate model were assigned a point value corresponding to the odds ratio (OR) divided by the smallest OR identifed in the regression model, and the resulting quotient was multiplied by two and rounded to the nearest whole number. Summation of the points generated by the calculated risk factors resulted in a quantitative score that was assigned to each patient in the database. Predictive performance was determined by assessing discrimination and calibration. The sensitivity, specifcity, positive predictive value, negative predictive value, and accuracy were calculated for diferent cutofs of the score. The incidence of CRE acquisition signifcantly increased with time from 0.21 cases/1000 patient-days (PD) in 2015 to 1.89 cases/1000PD in 2019 (r 2 = 0.789, P = 0.041). Multivariate analysis of matched data revealed that the history of cerebrovascular disease (OR 1.96; 95% CI 1.04–3.70; P = 0.039), hematopoietic cells transplantation (OR 7.75; 95% CI 1.52–39.36; P = 0.014), presence of a chronic wound (OR 3.38; 95% CI 1.73–6.50; P < 0.001), endoscopy done during the 3 months preceding the index hospitalization (OR 2.96; 95% CI 1.51–4.73; P = 0.01), nosocomial site of acquisition of the organism in question (OR 2.68; 95% CI 1.51–4.73; P = 0.001), and the prior use of meropenem within 3 months of CRE acquisition (OR 5.70; 95% CI 2.61–12.43; P < 0.001) were independent risk factors for CRE acquisition. A risk score ranging from 0 to 25 was developed based on these independent variables. At a cut-of of ≥ 5 points, the model exhibited a sensitivity, specifcity, positive predictive value, negative predictive value, and accuracy of 64.5%, 85.8%, 82%, 70.7% and 75%, respectively. We also showed that only meropenem consumption intensity and CRE acquisition incidence density OPEN 1 Department of Internal Medicine, Division of Infectious Diseases, Makassed General Hospital, Beirut, Lebanon. 2 Pharmacy Department, Makassed General Hospital, Beirut, Lebanon. 3 Faculty of Pharmacy, Lebanese University, Beirut, Lebanon. 4 Faculty of Medicine, Lebanese University, Beirut, Lebanon. 5 Department of Internal Medicine, Makassed General Hospital, Beirut, Lebanon. 6 Department of Medical Research, Makassed General Hospital, Beirut, Lebanon. 7 Faculty of Arts and Sciences, American University of Beirut, Beirut, Lebanon. 8 Department of Laboratory Medicine, Makassed General Hospital, Beirut, Lebanon. * email: moghniehrima@gmail.com