Prevalence of Carbapenem-Resistant Enterobacterales in Healthcare and Community Settings in the United Kingdom: A Systematic Review and Meta-Analysis

Abstract

Introduction: Carbapenemase producing Carbapenem-Resistant Enterobacterales (CP-CRE) pose a growing threat in the UK, with increasing prevalence in recent years and are associated with higher mobidity, mortality and healthcare costs. This review aims to synthesise evidence in the prevalence of CP-CRE in healthcare and community settings in the UK.

Methods: A systematic review was conducted across major five databses and two preprint websites up to 14.02.2024. Records were assessed in Covidence for eligibility and relevant articles were identified, screened and included. Metadata from selected studies were extracted and methodological quality was evaluated using an adapted Newcastle-Ottawa Scale. Pooled CP-CRE prevalence rates with 95% confidence intervals were assessed using ChI2 and I2, publication bias was evaluated using Egger’s test and funnel plot, and sensitivity analyses were performed.

Results: Following the screening of 1,344 records, 32 studies were included, providing data on CP-CRE prevalence, either in carriage or infection. In healthcare settings, the overall pooled prevalence of CRE and CPE was at 1.17% (95%Cl 0.29%-2.51%, I2 = 99.70%, n-171,107) and 1.06% (95%Cl 0.59%-1.64%; I2= 97.60, n=263,833), respectively. For CPE, a high pooled proportion was observed in healthcare carriage samples at 1.23% (95%Cl: 0.68%-1.91%; I2=98.10%; n=262,524) compared to infection samples at 0.03% (95%Cl: 0.00%-0.37%; I2=0.00%; n=888). Surveillance of CPE in healthcare facilities varied, with risk-based admission screening identifying a slightly higher CPE proportion of 1.27% (95%Cl: 0.97%-1.60%; I267.30%; n=24,763) compared to universal hospital screening at 0.82% (95%Cl: 0.28%-1.65%; I2= 97.90%; n=232,033). In the community, only two studies reported CPE prevalence (0.11%; 95%Cl: 0.00%-0.79%; I2=52.60; n=2,630) from carriage samples using point prevalence surveys, showing a relatively low prevalence.

Conclusion: This review provided an overview of the expected prevalence rates of CP-CRE in different contexts, which can further support the national surveillance of CP-CRE in the UK, enabling more targeted screening efforts for CP-CRE detection.