Intestinal colonization of carbapenem-resistant Enterobacteriaceae and associated factors in rural residents in Weifang: a cross-sectional survey

Objective To investigate the intestinal colonization rate of carbapenem-resistant Enterobacteriaceae (CRE) among rural residents in Weifang city, Shandong province and identify the associated factors, thereby providing evidence for the prevention and control of drug-resistant bacteria at the community level.

Methods In November 2023, a multi-stage stratified random sampling method was employed to select 833 rural residents from 12 villages in Weifang city, Shandong province. Questionnaire surveys and fecal sample CRE detection were conducted. The colonization rate of CRE in the intestine and the associated factors were analyzed.

Results Among the 767 rural residents ultimately included in the analysis, 59 individuals had fecal samples that tested positive for CRE, resulting in an intestinal colonization rate of CRE being 7.69%. Among the 59 samples that tested positive for CRE strains, 38, 5, 5, 4, 4, 2, and 1 samples were positive for Escherichia coli (64.41%), Escherichia albertii (8.47%), Enterobacter hormaechei (8.47%), Klebsiella pneumoniae (6.78%), Proteus mirabilis (6.78%), Citrobacter freundii (3.39%), and Klebsiella variicola (1.69%), respectively. Multivariate unconditional logistic regression analysis revealed that drinking unboiled well water or tap water (OR = 3.36, 95%CI: 1.16–9.71) and using animal manure as fertilizer (OR = 2.10, 95%CI: 1.05–4.24) were positively correlated with the intestinal colonization rate of CRE among rural residents in Weifang city. In contrast, handwashing after using the toilet (OR = 0.32, 95%CI: 0.15–0.70) and using an indoor toilet (OR = 0.18, 95%CI: 0.05–0.73) were negatively correlated with the intestinal colonization rate.

Conclusions The intestinal colonization rate of CRE is high among rural residents in Weifang city, Shandong province, with E. coli being the predominant species. Drinking unboiled well water or tap water, using animal manure as fertilizer, handwashing habits after using the toilet, and using an indoor toilet are significantly associated with CRE colonization in the local rural population.