Carbapenem-resistant Enterobacteriaceae (CRE) poses a growing threat in healthcare-associated infections, with limited therapeutic options. Klebsiella pneumoniae is the predominant causative agent globally. CRE, residing in the human intestine, serves as a risk factor for subsequent infections, presenting a healthcare challenge due to high morbidity and mortality rates. This study aimed to determine the prevalence of asymptomatic CRE carriers in an Intensive Care Unit (ICU) setting.The cross-sectional study spanned three years, involving rectal swab collection from ICU-admitted patients. Isolates underwent manual identification, carbapenem resistance screening, and susceptibility testing. Risk factors for CRE colonization were assessed using a composite questionnaire. The study revealed a prevalence of 3 to 7% CRE colonization, higher in ICU patients (13-51%). Active surveillance and compliance with infection control measures are essential in preventing CRE transmission, particularly in the ICU. The analysis of 584 rectal swabs highlighted gender-specific risk factor distributions. Males showed higher CRE colonization rates, particularly with high-end antibiotic exposure and Foley's catheterization. Escherichia coli dominated CRE isolates (70.27%), followed by Klebsiella pneumoniae (18.92%) and Enterobacter cloacae (10.81%).Discussion focused on the challenges posed by MDR bacteria, emphasizing the importance of hand hygiene and resource limitations in underdeveloped countries for CRE surveillance. Despite no consensus on the best detection method, rectal swabs emerged as a sensitive tool for active surveillance. Critically ill CRE-colonized patients face higher infection risks, emphasizing the need for tailored interventions.The study faced limitations, including single-time rectal screening and unexplored resistance mechanisms. The absence of clonality assessments restricted determining if CRE bacteremia resulted solely from colonization. Turnaround time, isolation duration uncertainties, and dedicated beds in the ICU also posed challenges.In conclusion, the study advocates for early CRE detection through rectal swab screening. However, challenges persist in effectively controlling colonization and infection rates. Active surveillance's impact relies on robust preventive measures and cohesive team communication. Future research should address limitations and delve into molecular characteristics for better treatment and infection control.