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

This systematic review and meta-analysis of 89 studies involving 116,743 participants estimates the global prevalence of carbapenem-resistant Enterobacteriaceae (CRE) colonization at 14%, with substantial heterogeneity across studies. Prevalence peaked in 2017 (33%) and declined to 8% by 2023, with marked geographic variation—highest in Vietnam (43%) and lowest in the United States (5%). Colonization was significantly more common in hospital settings (18%) and under universal screening approaches (20%) compared with community settings and targeted or systematic sampling. Hospital setting was the only study-level factor independently associated with higher prevalence. Klebsiella pneumoniae and Escherichia coli predominated, with NDM and OXA-type carbapenemases most frequently identified. The findings highlight CRE colonization as an ongoing global threat, particularly in healthcare environments, and emphasize the need for standardized surveillance, targeted infection control, and robust molecular monitoring of resistance mechanisms.