Gastrointestinal colonization with carbapenem-resistant Enterobacterales (CRE) is “alarmingly prevalent” worldwide, with significant variations across regions, researchers reported today in the American Journal of Infection Control.
In a systematic review and meta-analysis, Chinese researchers analyzed 89 studies that reported the prevalence of CRE colonization in 116,473 participants. CRE colonization of the gastrointestinal tract is important to monitor, the study authors note, because carriage of the multidrug-resistant bacteria frequently precedes invasive disease, particularly in critically ill hospital patients, and can persist for months and serve as a reservoir for hospital-based CRE outbreaks. But few studies have provided a “comprehensive synthesis” that integrates findings across populations, regions, and screening methods.
“By providing a global synthesis of CRE epidemiology, this review aims to inform infection control policies and prioritize surveillance strategies in both high- and low-resource settings,” the authors wrote.
14% pooled CRE colonization rate
Pooled CRE colonization prevalence across the 89 studies was 14%, with a peak of 33% in 2017, and a low of 8% in 2023. Among the countries included in the studies, Vietnam had the highest CRE colonization prevalence (43%), followed by Iran (39%), India (24%), Egypt (14%), and China (12%). The United States (5%) and Ethiopia (5%) had the lowest rates. Klebsiella pneumoniae (52.8%) and Escherichia coli (44.9%) were the most common organisms, and NDM (45.6%) and OXA-type (36.3%) were the predominant carbapenemase genes.
Subgroup analyses showed that children (18%) and newborns (15%) had similar CRE colonization prevalence rates as adults (13%), and that hospital-based (18%) and universal screening (20%) yielded higher prevalence than community-based (3%) and targeted/systematic sampling (3% to 15%).
The authors note the 14% prevalence estimate is substantially higher than reported in previous reviews that were focused on specific settings or pathogens, but mirrors the timeline of CRE emergence and spread that’s been documented by public health authorities.
“These findings highlight the urgent need for standardized surveillance, particularly in high-risk environments, and support targeted infection control strategies to limit CRE spread,” the authors wrote. “Enhanced molecular monitoring and further research into colonization dynamics and clinical outcomes are essential to inform public health responses.”