Carbapenem antibiotics are widely used in ICU, and the prevalence of carbapenem-resistant microorganisms (CRO) has increased. This study aimed to assess the role of individualized active surveillance using Xpert Carba-R of carbapenem resistance genes on CRO risk. A total of 3,765 patients were admitted to the ICU of Zhongnan Hospital of Wuhan University between 2020 and 2022. The presence of carbapenem resistance genes were monitored using Xpert Carba-R, and CRO incidence was assigned as the investigated outcome. Of 3,765 patients, 390 manifested the presence of CRO, representing a prevalence of 10.36%. Active surveillance using Xpert Carba-R was associated with a lower CRO risk (odds ratio [OR]: 0.77; 95% confidence interval [CI] 0.62–0.95;P= 0.013), especially for carbapenem-resistant Acinetobacter + carbapenem-resistantPseudomonas aeruginosa(OR: 0.79; 95% CI 0.62–0.99;P= 0.043), carbapenem-resistantKlebsiella pneumoniae(OR: 0.56; 95% CI 0.40–0.79;P= 0.001), and carbapenem-resistant Enterobacteriaceae (OR: 0.65; 95% CI 0.47–0.90;P= 0.008). Individualized active surveillance using Xpert Carba-R may be associated with a reduction in the overall CRO incidence in ICU. Further prospective studies should be performed to verify these conclusions and guide further management of patients in ICU.