The Silent Spread of Resistance: Global Patterns of CRE Colonization across Healthcare and Community Settings

This meta-analysis of 89 studies (116,743 participants) finds that global colonization with carbapenem-resistant Enterobacteriaceae (CRE) remains substantial, with a pooled prevalence of 14%, highest in Vietnam (43%) and Iran (39%) and lowest in the US and Ethiopia (5%). Prevalence is similar across age groups, including children and neonates, and is markedly higher in hospital settings—especially when universal admission screening is used—compared with community-based or systematic sampling. Klebsiella pneumoniae and E. coli account for most colonization cases, and NDM and OXA carbapenemases dominate. Despite a decline since a 2017 peak, CRE remains a major global threat, highlighting the need for standardized surveillance, strengthened hospital infection control, and molecular monitoring of resistance mechanisms.