Risk factors associated with rectal carriage of carbapenem resistant Enterobactorales in northern Nigeria: A hospital surveillance

Risk factors associated with rectal carriage of carbapenem resistant Enterobactorales in northern Nigeria: A hospital surveillance | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risk factors associated with rectal carriage of carbapenem resistant Enterobactorales in northern Nigeria: A hospital surveillance Yahaya Yaqub, Yusuf Muhammed, Bishir Musa, Zainab Rabilu Daninna, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7223251/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Oct, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted 15 You are reading this latest preprint version Abstract Background Carbapenem resistant Enterobacterales (CRE) are important cause of antimicrobial resistance (AMR). AMR is a global problem that disproportionately affects the low and middle income countries (LMIC) more. Appreciating what these risk factors were before the recent COVID-19 epidemic would help appreciate what changes have happened in the post COVID-19 era. Methods This was a hospital-based cross-sectional study conducted in 2017 in the largest tertiary health facility in northern Nigeria. Epidemiologic risk factors of interest were investigated using an interviewer administered questionnaire, followed by collection of a rectal swab sample. Regression analyses were conducted to appreciate what were the strengths of association between the outcome of interest as rectal carriage of CRE and the investigated risk factors. Results Rectal carriage of CRE was 4.2% (N=168) in this study. Age was independent protective risk factor (adjusted OR=0.2, CI:0.04 - 0.98, p=0.047) for the rectal carriage of CRE. Education appeared protective (OR=0.21, CI:0.06 - 0.76, p=0.018) while length of admission stay in Nigeria was not protective (adjusted OR=3.9, CI: 1.12 - 13.49, p=0.030) against rectal carriage of CRE. Also the ward a patient was admitted into was an important non-protective risk factor (aOR= 3.1, CI:1.14 - 8.20, p=0.030) for rectal carriage of CRE. Conclusions Epidemiologic risk factors for rectal carriage of CRE are quite similar within the LMIC context. It will be important to appreciate how these risk factors have changed since the COVID-19 pandemic. This would help make policies that focus on the most efficient counter measures to reduce the burden antimicrobial resistance in the LMIC. CRE Risk factors Antimicrobial resistance Epidemiological surveillance COVID-19 LMIC Nigeria Introduction The description of antibiotic resistance by bacteria was first towards single agent but these resistance pattern has since changed to been exhibited towards many agents of different classes and modes of action.1 Various mechanisms of antibiotic resistance have been described but production of enzymes that hydrolyse the agent is most frequently utilized against the beta-lactam group of antibiotics. These enzymes are collectively called the beta-lactamases and importantly include the carbapenemases.2 The clinical report of carbapenemases producing Enterobacterales (CPE) in 1993 was a major setback to the already established problem of antibiotic resistance.3 Carbapenamases have long been reported to be transferable on plasmids which makes them highly among the Enterobacterales.4 As Enterobacterales are commensals of the gut, this site provides them with a haven which they use to transit between the hospital and the community.5-7 The Centre for Disease Control and Prevention (CDC) and European Centre for Disease Prevention and Control (ECDC) classified bacterial pathogens into; Multidrug-resistance (MDR) to organisms showing in-vitro resistance to one antibiotic agent in three or more antibiotic classes, extensively drug-resistance (XDR) to those showing susceptibility to only one or two categories and Pan drug-resistance (PDR) to those showing susceptibility to no agent in any category.8 The CPE were put in the MDR class although this is not exclusive and has being described in virtually all known pathogenic.9 Recently, CRE were listed in the “critical category” of the World Health Organization (WHO) bacterial priority pathogens, highlighting the impact of these pathogens on global health currently and the foreseeable future.10 Initially resistant Enterobacterales were more often associated with hospitalized patient and the hospital environment arguably due to the constant interaction between these organisms and the use of different antibiotics in the hospital.6, 11, 12 Reports of recovery from MDRO’s from community sewages further consolidates the intestinal origin of these organisms which adds to the already established hand carriage.13-15 A wider epidemiological fact is that these MDROs show a geographically describable globally.16 CPE were reported to account for between 2-7% of infection in USA, Europe, and Asia among ICU patients while up to 25% Klebsiella spp isolates has been reported show carbapenem resistance in Greece.2 However, in Nigeria there have been reports of CPE isolates from clinical from Kano,17, 18 Abeokuta19 and Lagos.20 A systematic review recently reported that the increase of resistance to carbapenem was seen the most compared to other antibiotics among Gram negative bacteria. Also, the review proposed that about 92 million deaths projected (i.e. across all age groups) to be attributable to AMR between 2025 and 2030, could be averted through provision of better care for sever infections and improved access to antibiotics.21 Infections by MDROs have been associated with a delay in initiation of appropriate therapy, long hospital stay, increased medical bill and a high mortality.22 There is however, a dearth a research in the area of rectal surveillance from this Nigeria. It was our ardent hope that this study adds an objective appreciation of the magnitude of CPE rectal carriage problem among in-patients during the period just preceding the recent COVID-19 pandemic. The objectives of this study were; 1. To determine the prevalence of faecal colonization by CPE among in-patients, 2. To determine the risk factors associated with faecal colonization by CRE among in-patients, and 3. To appreciate which risk factors are independently associated with faecal colonization by CPE among in-patients. Methods Study area This study was carried out at Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Kaduna state in the North-western region of Nigeria. The hospital is a tertiary health centre with a 1,000-bed capacity. As a referral health facility, it receive about 10,000 patients visit the facility each year from all parts of the country. Study design This was a cross-sectional study to describe the association of risk factors and rectal CRE carriage among hospitalised patients at ABUTH Zaria. It involved an interviewer administered questionnaire followed by rectal swab sample collection from participants in the following wards; (medical, surgical, paediatrics, gynaecology and oncology), Intensive Care Unit (ICU) and Special Care Baby Unit (SCBU). These samples were processed at the medical microbiology laboratory of ABUTH, Zaria. Sample size calculation Cross-sectional sample size calculator on Epi info 7 was used with the following parameters; power of 80%, two-sided confidence interval of 95% and expected outcome in the unexposed was 11% (from a similar study 23 ). The total sample size of 168 was arrived at for the Kelsey’s method. Inclusion criteria Patients who were admitted into the medical, surgical, paediatrics, gynaecology, oncology, ICU and SCBU. Exclusion criteria Patients who either had a colostomy or were on dialysis were excluded from this study. Sampling technique The sample size of 168 was divided across the seven units equally leading to recruitment of twenty-four patients in each unit. Patients on odd numbered beds were recruited during a single visit. Subsequently new patients were enrolled if they were on odd numbered beds. This process continued until the sample size was reached. However, all patients from the ICU and SCBU were recruited in a non-repetitively fashion due to the scarcity of patients. Patients’ recruitment and rectal sab laboratory processing was between January 2017 and November 2017 (i.e. 10 months). Data collection tools This involved an interviewer administered questionnaire followed by rectal swab collection. Questionnaire A questionnaire, designed for this study, was used to collect information on the thirty-three associated risk factors of interest (See appendix 1). These risk factors were divided into four section i.e. 1. Demographic risk factors (e.g. age, sex, education, etc); 2. Environmental risk factors (e.g place of residence, living with animals, toilet facility, etc); 3. Current hospital risk factors (ward, length of stay, antibiotic use, etc); 4. Past hospital risk factors (e.g. Previous hospital admission in Nigeria within the past 1 year, Length of hospital stay in Nigeria within the past 1 year, Previous hospital admission outside Nigeria within the past 1 year, etc. The outcome of interest was the rectal carriage of CRE. Rectal swab sample collection and processing A labelled rectal swab was collected with an Amies transport swab, . 24 from all participants in this study. The rectal swab sample was collected, transported to the lab, then Gram negative bacterial isolation, screening and confirmation for CRE and molecular characterization done as described by Yaqub et al. 25 Data analysis Data from each participant was entered into and cleaned in Excel spreadsheet. Binary entries were coded as 1= yes and 0= no while ordinal categorical entries were coded as 1, 2, 3 etc. Continuous data (i.e. “age (days)” and “length of hospital stay”) were stratified appropriately into weeks while “age (years)” was stratified into decades i.e. 1-10, 11-20 etc. All statistical analyses were done in Stata 14 (StataCorp LP, College Station, USA). Two-sided p-values ( < 0.05) and confidence intervals (CI) of 95% were used for significance testing in this study. Prevalence of CRE rectal carriage was determined for the study. A Pearson chi-square (X 2 ) test (i.e. 2-sided value) was used to check for association between CRE rectal carriage and information on risk factors (i.e. variables) collected in the questionnaire. Odds ratio (OR) was calculated for these associations to check for strength and nature of the variables to CRE rectal carriage. Logistic regression analyses were conducted to control for the confounding effects of the significantly associated risk factors observed in the study. All p values for this study were two-sided and p≤0.05 was considered significant. All CIs were 95% and were only considered good if they did not include the null figure (i.e. 0 for χ2 tests and 1 for OR) and not wide from the observed values. Results The prevalence of rectal carriage of CRE was 4.2% (N=168). The distribution of isolates in this study were E. coli (83%), Klebsiella pneumoniae (15%) and Enterobacter aerogenes (2%). All CRE (n=7) were Klebsiella pneumonia (n=22). Descriptive statistics of risk factors for rectal carriage of CRE The ages of participants in SCBU were categorized into 1 st through 4 th week of life and for other participants, the ages were in years and thus categorized into decades i.e. 1-10, 11-20, etc. There was an increasing proportion of CRE carriage among participants with every increase in decade and the pooling of this finding was in those >60 years. The current or past history length of hospital stay (in “days”) of the participants i.e., within and outside Nigeria in the past year, were categorised into weeks and a relationship appeared to exist with rectal carriage of CRE. Educational status of the participants appeared to affect rectal carriage of CRE in a decreasing manner with increasing educational exposure. Complete results on demographic risk factors can be found in Table 1. There was an almost equal distribution for rectal carriage of CRE irrespective of the type of residence the participants lived in or their toilet facility. The proportion of CRE carriage was highest in those who drank borehole water (16.7%, n=6). Detailed results on environmental risk factors can be found in Table 2. CRE carriage was found in ICU and SCBU at 20.8% and 8.3% respectively. There was an increasing proportion of CRE carriage with every increase in week of hospital admission. Other risk factors on “current hospital admission” can be found in Table 3. Those with a history of previous admission in Nigeria were near in proportion to those with no such history 75% and 88.5% respectively. However all those who had a history of admission outside Nigeria did not carry ESBL-PE (n=3). Other past hospital risk factors can be found in Table 4. Evidence of the existence of association between risk factors and rectal CRE carriage The ward a patient was admitted into had a very strong association with CRE carriage ( X 2 =22.9, p=0.001). However age was quite significantly associated with CRE carriage only in adult patients ( X 2 13.0, p=0.07). The present length of hospital stay ( X 2 =12.7, p=0.03) and educational status ( X 2 =7.6, p=0.06) were also associated with CRE carriage. The working diagnosis, i.e. whether an infectious or not, ( X 2 0.2, p=0.64) was not associated with CRE carriage. (See Table 5). Strength of the observed association of risk factors to rectal CRE carriage The ward a patient was admitted was significantly associated with CRE carriage and wasn’t due to chance (OR 1.5, CI 1.03 - 2.19, p=0.03). Every decade increase in patients’ age was also found to significantly increase the risk of CRE carriage (OR 1.79, CI 1.13 - 2.84, p=0.01). Marital status though was found to marginally increase the risk of CRE carriage, this association may have been due to chance (OR 1.1, CI 0.29 - 4.15, p=0.9). Present hospital admission though was associated with CRE carriage, the increased risk associated with it may have been due to chance as well (OR 1.7, CI 0.90 - 2.99, p=0.1). (See Table 6). Independence of association between risk factors and rectal CRE carriage A logistic regression revealed that the risk of CRE carriage doubled for the ward a patient was admitted into after controlling for the confounding effect of other associated variables (unadjusted OR 1.5 & adjusted OR 3.1, CI 1.14 - 8.20, p=0.03). Also the risk posed by present hospital admission on CRE carriage more than doubled as well (unadjusted OR 1.7 & adjusted OR 3.9, p=0.03, CI 1.12 – 13.49). There was a reduction in the protection from CRE carriage a patient enjoyed due to young age once the confounding effect of other important risk factors were controlled for remarkably however is that this protection was not due to chance (unadjusted OR 1.8 & adjusted OR 0.2, p=0.47, CI 0.04 - 0.98). (See Table 7). The educational status of the participant was protective from the crudes odds ratio (Unadjusted OR=0.2, p=0.0103, CI 0.06 - 0.69). This protective effect was not affected despite controlling for other risk increasing variables through a univariate analysis (ORs were around 0.2, p values were 0.05 & CIs contained 1). (See Table 8). Table 1: Description of participants’ demographic risk factors for rectal carriage of CRE. Variables Proportion of CRE n (%) Age (SCBU in days) n=24 1 st week 2/7 (28.6) 2 nd week 0/9 (0) 3 rd week 0/6 (0) 4 th week 0/2 (0) Age (Adults in years) n=144 1-10 0/22 (0) 11-20 0/2 (0) 21-30 0/23 (0) 31-40 1/28 (3.6) 41-50 0/25 (0) 51-60 1/26 (3.9) 61-70 2/14 (14.3) 71-80 1/4 (25) Sex N=168 male 5/71 (7) Female 2/97 (2.1) Tribe N=168 Hausa 5/96 (5.2) Igbo 0/11 (0) Yoruba 1/12 (8.3) Others 1/49 (2.0) Marital status N=168 Single 2/60 (3.3) Married 5/103 (4.9) Widowed 0/3 (0) Divorced 0/2 (0) Occupation N=168 Trader 2/27 (7.4) Farmer 5/119 (4.2) Civil Servant 0/22 (0) Educational status N=168 None 2/10 (20) Primary or Islamic 1/14 (7.1) Secondary 4/131 (3.1) Tertiary 0/13 (0) Table 2: Description of participants’ environmental risk factors for rectal carriage of CRE. Variables Proportion of CRE n (%) Place of residence N=168 Kaduna 6/113 (5.3) Northwest States 1/30 (3.3) Other northern States 0/19 (0) Other parts of Nigeria 0/6 (0) Type of residence N=168 Individual house 1/31 (3.2) Shared compound 6/137 (4.4) Living with Animals N=168 Yes 6/123 (4.9) No 1/45 (2.2) Water source N=168 Well or spring 5/103 (4.9) Public tap 1/59 (1.7) Private borehole 1/6 (16.7) Toilet facility N=168 Shared with public 4/124 (3.2) Open defaecation 1/19 (5.3) Private 2/25 (8) Table 3: Description of participants’ current hospital risk factors for rectal carriage of CRE. Variables Proportion of CRE n (%) Wards N=168 Medical 0/24 (0) Surgical 0/24 (0) Gynaecology 0/24 (0) Oncology 0/24 (0) ICU 5/24 (20.8) Paediatrics 0/24 (0) SCBU 2/24 (8.3) Working diagnosis N=168 Infectious 7/163 (4.3) non-infectious diseases 0/5 (0) Length of hospital stay(days) N=168 1 st week 1/73 (1.4) 2 nd week 2/44 (4.6) 3 rd week 3/25 (12) 4 th week 0/17 (0) 5 th week 0/6 (0) 6 th week 1/3 (33.3) Antibiotic use N=168 Yes 168/168 (100) Beta-lactam use N=168 Yes 168/168 (100) Other antibiotic use N=168 Yes 7/154 (4.6) No 0/14 (0) Table 4: Description of participants’ past hospital risk factors for rectal carriage of CRE Variables Proportion for CRE N=168 (%) Previous hospital admission in Nigeria within the past 1 year Yes 0/12 (0) No 7/156 (4.5) Length of hospital stay in past year in Nigeria None 7/156 (4.5) 1 week 0/3 (0) 2 weeks 0/6 (0) 3 weeks 0/3 (0) Antibiotic use in Nigeria Yes 0/12 (0) No 7/156 (4.5) Beta-lactam use in Nigeria Yes 0/12 (0) No 7/156 (4.5) Other antibiotic use in Nigeria Yes 0/11 (0) No 7/157 (4.5) Previous hospital admission outside Nigeria in the past 1 year Yes 0/3 (0) No 7/165 (4.2) Length of hospital stay in past year outside Nigeria (days) None 7/165 (4.2) 14 days 0/1 (0) 22 days 0/1 (0) 27 days 0/1 (0) Antibiotic use outside Yes 0/3 (0) No 7/165 (4.2) Beta-lactam use outside Yes 0/3 (0) No 7/165 (4.2) Other antibiotic use outside Yes 0/3 (0) No 7/165 (4.2) Table 5: Evidence of the existence of association between some risk factors and rectal carriage of CRE. Variables X 2 P value Ward 22.9 0.001 Age_days (SCBU) 5.2 0.151 Age_years (Others) 13.02 0.072 *Marital status 6.9 0.072 Length of hospital stay (present) 12.7 0.027 Educational status 7.6 0.056 Working diagnosis 0.2 0.636 Having diarrhoea 0.6 0.474 Sex 2.6 0.111 Tribe 1.9 0.612 See full table of risk factor associations with CRE faecal colonization in Supplemental Table. Table 6: The strength of association between rectal carriage of CRE and significant risk factors. Variable Odds Ratio P value CI Patients’ ward 1.5 0.0342 1.03 - 2.19 Patient’s Age years 1.79 0.0132 1.13 - 2.84 Marital status 1.1 0.8878 0.29 - 4.15 Educational status 0.2 0.0103 0.06 - 0.69 Length of hospital stay 1.7 0.1031 0.90 - 2.99 Table 7: Logistic regression showing the nature of association between significant risk factors (dependent variables) and rectal carriage of CRE after controlling for the confounding effect other significant variables. Dependent variable Controlled Variables Unadjusted OR Adjusted OR P value CI Patients’ age (years) Educational status, length of hospital stay and ward 1.8 0.2 0.047 0.04 - 0.98 Length of hospital stay (present) Ward, Educational status and age (years) 1.7 3.9 0.032 1.12 - 13.49 Patients’ ward Educational status, age (years) and length of hospital stay 1.5 3.1 0.03 1.14 - 8.20 Table 8: The protective effect (i.e. bivariate and multivariate analysis) of educational status on rectal CRE carriage after adjusting for other variables. Controlled Variables Odds ratio P value CI Patients’ ward 0.18 0.0077 0.05 - 0.63 Length of hospital stay in Nigeria 0.22 0.0185 0.06 - 0.78 Age (years) 0.25 0.0227 0.08 - 0.83 Patients’ ward and age (years) 0.21 0.0176 0.06 - 0.76 Length of hospital stay in Nigeria and age (years) 0.35 0.0768 0.11 - 1.12 Patients’ ward and length of hospital stay in Nigeria 0.27 0.0911 0.06 - 1.23 Patients’ ward, age (years) and length of hospital stay in Nigeria 0.37 0.1573 0.09 - 1.47 (Unadjusted OR=0.2, p=0.0103, CI 0.06 - 0.69) Discussion The prevalence rectal carriage of CRE was 4.2% (N = 168) in this study. This was slightly different from that from an earlier study with similar design but smaller sample size (n = 77) in Morocco which found a higher CRE (10%) rectal colonisation (CI -0.66% 14.77%, p = 0.08). 26 However, a cohort study with a bigger sample size found a CRE rectal colonization rate of 10.0% (n = 330) which not statistically different from that observer in this study (CI 1.59% − 11.08%, p = 0.011). 23 The demographic risk factors of significance were age and educational status. From Table 1 above, the first week of life for patients in the SCBU appeared to particularly expose patient to rectal carriage of CRE but had no evidence of statistical association (X 2 = 5.2, p = 0.151) as shown in Table 5 . For other participants however, there was an increasing proportion of CRE rectal colonization through every increase in decade of life with a pool of findings in the > 60 year olds with some association (X 2 = 13, p = 0.07). The apparent increasing odds ratio (unadjusted OR = 1.8) with every increase in the decade of life associated with rectal carriage of CRE, disappeared once the effect of other significant risk factors (i.e. patient’s ward, length of hospital stay and educational status) were controlled for (adjusted OR = 0.2, CI 0.04–0.98, p = 0.047) as shown in Table 6 . Thus once the effect of ward and length of hospital stay were controlled for, the OR of age dropped significantly and CI widened. As such it can be inferred that the age of patient is an independent protective factor for rectal carriage of CRE if patients are not admitted into critical wards (ICU and SCBU). A recent study in the south-western city (i.e. Ibadan) in Nigeria found a similarly high burden in the latter decades of life. 27 A recent systematic review reported age (i.e. >5 years) as an important factor for the increase in death associated with antibiotic resistant pathogens. 21 Although female participants were slightly more than males in this study (i.e. Table 1 ), males had a higher rectal carriage of CRE but this may have been due to chance (X 2 = 2.6, p = 0.111). Attempts to find credible corroborating evidence on the role of gender (i.e. sex) on rectal colonization by CRE was futile and this is echoed by the Gautron et al. who argued in favour of a more gender inclusive consideration in AMR surveillance to fill this knowledge gap. 28 Most of the participants had secondary school as their highest level of education (n = 131) as shown in Table 1 . An interesting trend of decreasing proportion was found between CRE rectal colonization and increasing level of education of the participants which had some significant association (X 2 = 7.6, p = 0.056). Higher education status of participants appeared to be protective against CRE rectal colonization (unadjusted OR = 0.2, CI: 0.06–0.69, p = 0.01). An earlier study in Nigeria found a weak association (i.e. p > 0.05) with those with secondary education and above as having a higher chance of carrying MDR- E. coli . 29 However, a recent study from Uganda found that there was some protection offered by higher education as observed in this study. 30 Upon further analysis however, a univariate regression analysis separately controlling for the confounding effect of the “exposing” factors (i.e. patients’ ward (OR = 0.18, CI: 0.05–0.63, p = 0.008) and length of stay in Nigeria (OR = 0.22, CI: 0.06–0.78, p = 0.0185)) on the protection offered against CRE rectal colonization, by higher levels of education, the protective effect was not affected and were not due to chance as shown in Table 8 . A forward stepwise logistic regression was only significant for the effect of “age (years)” had in addition to patients’ ward on the protective effect of increasing level of education (OR = 0.21, CI: 0.06–0.76, p = 0.018). Interestingly, adjusting for the any of the other factors (i.e. age (years), patients’ ward and length of stay in Nigeria) nullified this observed protection offered by education as long as the risk factor “length of stay in Nigeria” was included as all the confidence intervals included the null figure i.e. 1 (See Table 8 ). Thus it can be inferred that increasing level of education could be protective against CRE rectal colonization if a patient has a short hospital stay and was not admitted into a critical unit (i.e. ICU or SCBU). Marital status was associated with rectal carriage of CRE (X 2 = 6.9, p = 0.072) by increasing the odds of rectal colonization by CRE among the married compared to those who are singles, but may be due to chance (OR = 1.1, p = 0.887, CI 0.29–4.15). A recent study having a different design (i.e. Knowledge attitude and Practice) found a similar poor association of marital status with antibiotic consumption on the emergence of antibiotic resistance. 30 Although there appeared to be a decreasing proportion of rectal carriage of CRE from traders to farmers to civil servants (see Table 1 ), no association was found with the occupation of the participants (X 2 = 1.7, p = 0.435) and this was similar to the findings from a recent study in Uganda. 31 Tribe had no significant association with rectal carriage of CRE (X 2 = 1.8, p = 0.612) although the highest CRE carriage was among those who identified as Yoruba (8.3%, n = 12) (see Supplementary Table). Although none of the environmental risk factors was found to be statistically significant, all participants with rectal carriage of CRE came from the northwest including Kaduna state, no association was demonstrated statistically (X 2 = 1.5, p = 0.680). CRE rectal colonization was found more in those with shared hosing compared with those in individual housing but no association was found (X 2 = 0.08, p = 0.772). This is similar to a finding of systematic review that found that most studies they included did not have any significant association. 32 The finding that those with “private borehole” as their type of water source had the highest proportion of CRE carriage was quite surprising. However, a test of association later showed that the type of water source was not significant (X 2 = 3.37, p = 0.185). A 2023 paper published the findings of a study conducted in a Kenyan Hospital that came to a similar conclusion to that from this study conducted before the COVID pandemic. 33 Toilet facility whether private, shared or open defecation had no association with CRE carriage as well (X 2 = 1.25, p = 0.535) which was similar to that observed from the Kenyan study mention earlier. 33 The ward a participant was admitted into as well as their length of stay on admission as at the time of conduct of this study, were the risk factors of significance in the “current hospital risk factors” category. All the participants with rectal carriage of CRE (n = 7) were from the critical wards (i.e. ICU and SCBU) as shown in Table 3 . This observation was found to have a very strong association with CRE faecal colonization (X 2 = 23, p < 0.001). A logistic regression analysis, controlling for other significantly associated variables (i.e. educational status, age (years) and length of hospital stay), revealed that the ward a patient was admitted into had an independent association with CRE rectal colonization evidenced by the doubling odds ratio (unadjusted OR = 1.5 & adjusted OR = 3.1, CI: 1.14–8.20, p = 0.03) as shown in Table 7 . ICU patients have been reported to have a higher risk of getting colonised by CRE and subsequently getting infected by these pathogens. 34 The length of hospital stay in Nigeria though collected in days, was categorised into weeks to have better epidemiological meaning as depicted in Table 3 . A trend of increasing proportion for rectal carriage of CRE with every increase in week spent on the ward became apparent and this was found to have significant association (X 2 = 12.7, p = 0.027). Controlling for the effect that other significant risk factors (i.e. age (years), patients’ ward and education status) led to the odds ratio to more than doubled for length of hospital stay for the patient who had been rectal colonised by CRE (unadjusted OR = 1.7 & adjusted OR = 3.9, CI: 1.12–13.49, p = 0.03). A prediction model proposed by Lin and colleagues found length of hospital stay to be an independent risk factor for CRE rectal colonization. 35 Similarly, another study showed that length of hospital stay was strongly associated with colonization by multidrug-resistant Gram-negative bacteria. 36 Any participant who had a record of infection in the current admission as at the time of this study were put into the “infection” category of the variable “Working diagnosis”. This may have contributed to the large number of those with infection (n = 163) of whom had CRE carriage. The working diagnosis of the participant was however not associated with rectal CRE carriage (X 2 = 0.22, p = 0.64) even though all the CRE rectal carrying individuals were in the “infection” category. The report of rectal carriage of CRE preceeding infections among inpatients has being previously documented but wasn’t part of the objectives of this study. 37 , 38 All participants in this study had taken a beta-lactam antibiotic during the current admission and thus had no association. This could highlight the liberal use of beta-lactam antibiotic antibiotics in the context that this study was carried out which could be a contributor to AMR or reflect the lack of a functional antimicrobial stewardship program in our context. A more recent study reported that previous antibiotic use significantly increased the risk of carrying carbapenemase producing Enterobacteriaceae which is different observation from that of this study. 39 Having travelled abroad for medical attention (with or without antibiotic usage), a relative who went for medical attention outside Nigeria (with or without antibiotic usage) or how long the relative stayed did not have any association with CRE carriage among the participants (see supplemental table). Most of the participants had not been admitted into a hospital in Nigeria in the preceding twelve months but interesting all rectal CRE carriage was in this sub-population of participants. As such, a history of previous admission, how long the admission was or a history of any form of antibiotic use during such admission did not have any association with CRE carriage (see supplemental table). A case-control study carried out around the same time (i.e. 2014/2015) as this study in the Illinois, USA, reported a strong association of CRE carriage with admission in the previous one year. 40 Conclusion Despite the low prevalence of CRE carriage in this study, all were isolated from patients in ICU and SCBU. Critical wards like the ICU and SCBU have been reported from other studies as an important risk factor for the rectal carriage of CRE. Thus it can be inferred that the ward a patient is admitted into and how long the patient stayed in the hospital are independent factors for the carriage of CRE. 34 , 40 The length of hospital stay in Nigeria appeared to be an independent factor for colonisation while the level of education had some protective effect on the rectal carriage of CRE. It will be important to keep an eye on the critical units such as ICU and SCBU, as all these MDROs were found there. As a follow up data collection wasn’t part of this study’s design, information on the outcome of the patients (i.e. discharged alive or died) was not collected and such any relationship couldn’t be established. However, as this study was conducted in the pre-COVID 19 period, it could serve as a reference to with for future similar studies. Importantly also, further studies would be necessary to appreciate what the nature of these risk factors are to CRE carriage in the post-COVID 19 period. Abbreviations CRE: Carbapenem Resistant Enterobacterales CPE: Carbapenemases producing Enterobacterales LMIC: Low and Medium Income Countries COVID-19: Coronavirus disease AMR: Antimicrobial Resistance ICU: Intensive Care Unit SCBU: Special Care Baby Unit CDC : Centre for Disease Control and Prevention ECDC: European Centre for Disease Prevention and Control MDR : Multidrug-resistance XDR: Extensively drug-resistance PDR : Pan drug-resistance WHO: World Health Organization ABUTH : Ahmadu Bello University Teaching Hospital Declarations Ethics approval and consent to participate: Ethical approval in accordance with the Declaration of Helsinki was obtained from the Ahmadu Bello University Teaching Hospital, Zaria Research Ethics Committee (Approval number: ABUTHZ/HREC/T20/2016). Informed consent to participate in the study was obtained from the parents or legal guardians of participants below the age of 16 years. Informed consent to participate in the study was obtained from participants aged 16 years and above. Clinical Trial number: not applicable. Consent for publication: Not applicable. Data availability: All data supporting the findings of this study are available within the paper and its Supplementary information. Competing interests: The authors have no competing interests to declare. Funding: No financial support was provided relevant to this article. Authors’ contributions: YY, AA, ZLT, and YM conceived and implemented the study. YY, AA, ZLT and YM were responsible for analysis and interpretation of data. YY, ZLT, MSA, BM, and YM were the major contributors to the manuscript. All authors read and approved the final manuscript. Acknowledgement: We appreciate the support of the management, ward staff and participating patients of the Ahmadu Bello University Teaching Hospital who participated in this study. References Herindrainy, P.; Randrianirina, F.; Ratovoson, R., et al. Rectal Carriage of Extended-Spectrum Beta-Lactamase-Producing Gram-Negative Bacilli in Community Settings in Madagascar, PloS one . 2011, 6, e22738. Ruppe, E.; Woerther, P. L.; Barbier, F. Mechanisms of antimicrobial resistance in Gram-negative bacilli, Annals of intensive care . 2015, 5, 61. Nordmann, P.; Gniadkowski, M.; Giske, C. G.; Poirel, L.; Woodford, N.; Miriagou, V. Identification and screening of carbapenemase-producing Enterobacteriaceae, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases . 2012, 18, 432-438. Queenan, A. M.; Bush, K. Carbapenemases: the Versatile β-Lactamases, Clinical Microbiology Reviews . 2007, 20, 440-458. Girlich, D.; Bouihat, N.; Poirel, L.; Benouda, A.; Nordmann, P. High rate of faecal carriage of extended-spectrum beta-lactamase and OXA-48 carbapenemase-producing Enterobacteriaceae at a university hospital in Morocco, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases . 2014, 20, 350-354. Isendahl, J.; Turlej-Rogacka, A.; Manjuba, C.; Rodrigues, A.; Giske, C. G.; Nauclér, P. Fecal Carriage of ESBL-Producing E. coli and K. pneumoniae in Children in Guinea-Bissau: A Hospital-Based Cross-Sectional Study, PloS one . 2012, 7, e51981. Moore, A. M.; Patel, S.; Forsberg, K. J., et al. Pediatric Fecal Microbiota Harbor Diverse and Novel Antibiotic Resistance Genes, PloS one . 2013, 8, e78822. Merli, M.; Lucidi, C.; Di Gregorio, V., et al. The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey, PloS one . 2015, 10, e0127448. Shestov, M.; Ontanon, S.; Tozeren, A. Encyclopedia of bacterial gene circuits whose presence or absence correlate with pathogenicity - a large-scale system analysis of decoded bacterial genomes, BMC genomics . 2015, 16, 773. Sati, H.; Carrara, E.; Savoldi, A., et al. The WHO Bacterial Priority Pathogens List 2024: a prioritisation study to guide research, development, and public health strategies against antimicrobial resistance, The Lancet Infectious Diseases . 2025, DOI 10.1016/S1473-3099(25)00118-5. Teo, J.; Cai, Y.; Tang, S., et al. Risk Factors, Molecular Epidemiology and Outcomes of Ertapenem-Resistant, Carbapenem-Susceptible Enterobacteriaceae: A Case-Case-Control Study, PloS one . 2012, 7, e34254. Ali Abdel Rahim, K. A.; Ali Mohamed, A. M. Prevalence of Extended Spectrum beta-lactamase-Producing Klebsiella pneumoniae in Clinical Isolates, Jundishapur journal of microbiology . 2014, 7, e17114. Weisenberg, S. A.; Mediavilla, J. R.; Chen, L., et al. Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae in International Travelers and Non-Travelers in New York City, PloS one . 2012, 7, e45141. Bogaerts, P.; Verroken, A.; Jans, B.; Denis, O.; Glupczynski, Y. Global spread of New Delhi metallo-β-lactamase 1, The Lancet Infectious Diseases . 2010, 10, 831-832. Abdallah, H. M.; Reuland, E. A.; Wintermans, B. B., et al. Extended-Spectrum β-Lactamases and/or Carbapenemases-Producing Enterobacteriaceae Isolated from Retail Chicken Meat in Zagazig, Egypt, PloS one . 2015, 10, e0136052. Garner, M. J.; Carson, C.; Lingohr, E. J.; Fazil, A.; Edge, V. L.; Trumble Waddell, J. An Assessment of Antimicrobial Resistant Disease Threats in Canada, PloS one . 2015, 10, e0125155. Yusuf, I.; Arzai, A.; Getso, M.; Sherif, A.; Haruna, M. P075: Emergence of carbapenem-resistant enterobacteriaceae in surgical and intensive care units of a hospital with low usage of carbapenem in Kano, North West Nigeria, Antimicrobial Resistance and Infection Control . 2013, 2, P75. Yusuf, I.; Arzai, A. H.; Haruna, M.; Sharif, A. A.; Getso, M. I. Detection of multi drug resistant bacteria in major hospitals in Kano, North-West, Nigeria, Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology] . 2014, 45, 791-798. Motayo, B. O.; Akinduti, P. A.; Adeyakinu, F. A., et al. Antibiogram and plasmid profiling of carbapenemase and extended spectrum Beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae in Abeokuta, South western, Nigeria, African Health Sciences . 2013, 13, 1091-1097. Enwuru, N. V.; Enwuru, C. A.; Ogbonnia, S. O.; Adepoju-Bello, A. A. Metallo-Β-Lactamase Production by Escherichia Coli and Klebsiella Species Isolated from Hospital and Community Subjects in Lagos, Nigeria., Nature and Science . 2011, 9 1-5. Global burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050, Lancet . 2024, 404, 1199-1226. Knudsen, J. D.; Andersen, S. E.; for the Bispebjerg Intervention, G. A Multidisciplinary Intervention to Reduce Infections of ESBL- and AmpC-Producing, Gram-Negative Bacteria at a University Hospital, PloS one . 2014, 9, e86457. Torres-Gonzalez, P.; Cervera-Hernandez, M. E.; Niembro-Ortega, M. D., et al. Factors Associated to Prevalence and Incidence of Carbapenem-Resistant Enterobacteriaceae Fecal Carriage: A Cohort Study in a Mexican Tertiary Care Hospital, PloS one . 2015, 10, e0139883. Lerner, A.; Romano, J.; Chmelnitsky, I.; Navon-Venezia, S.; Edgar, R.; Carmeli, Y. Rectal Swabs Are Suitable for Quantifying the Carriage Load of KPC-Producing Carbapenem-Resistant Enterobacteriaceae, Antimicrobial agents and chemotherapy . 2013, 57, 1474-1479. Yaqub, Y.; Ejembi, J.; Aminu, A., et al. Antibiotic resistance pattern of multidrug-resistant Enterobacterales from a rectal surveillance study in northern Nigeria, International health . 2025, DOI 10.1093/inthealth/ihaf026. Girlich, D.; Bouihat, N.; Poirel, L.; Benouda, A.; Nordmann, P. High rate of faecal carriage of extended-spectrum β-lactamase and OXA-48 carbapenemase-producing Enterobacteriaceae at a university hospital in Morocco, Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases . 2014, 20, 350-354. Adekanmbi, O.; Popoola, O.; Fowotade, A., et al. Prevalence of rectal carbapenem resistant Enterobacterales carriage among patients attending healthcare facilities in Ibadan, Nigeria: a descriptive study, BMC infectious diseases . 2024, 24, 726. Gautron, J. M. C.; Tu Thanh, G.; Barasa, V.; Voltolina, G. Using intersectionality to study gender and antimicrobial resistance in low- and middle-income countries, Health Policy and Planning . 2023, 38, 1017-1032. Aworh, M. K.; Kwaga, J.; Okolocha, E.; Mba, N.; Thakur, S. Prevalence and risk factors for multi-drug resistant Escherichia coli among poultry workers in the Federal Capital Territory, Abuja, Nigeria, PloS one . 2019, 14, e0225379. Salam, M. A.; Al-Amin, M. Y.; Salam, M. T., et al. Antimicrobial Resistance: A Growing Serious Threat for Global Public Health, Healthcare . 2023, 11, 1946. Ndagire, R.; Obuku, E. A.; Segawa, I., et al. Knowledge, attitude, and practices regarding antibiotic use and antimicrobial resistance among urban slum dwellers in Uganda, Antimicrobial Resistance & Infection Control . 2025, 14, 12. Köck, R.; Daniels-Haardt, I.; Becker, K., et al. Carbapenem-resistant Enterobacteriaceae in wildlife, food-producing, and companion animals: a systematic review, Clinical Microbiology and Infection . 2018, 24, 1241-1250. Mutuma, C. K.; Maingi, J.; Maina, A. K.; Njeru, J.; Musyoki, A. M. Asymptomatic gastrointestinal carriage of multidrug-resistant carbapenemase-producing Enterobacteriaceae among children under five years in a Kenyan hospital, IJID Regions . 2023, 9, 25-31. Yan, L.; Sun, J.; Xu, X.; Huang, S. Epidemiology and risk factors of rectal colonization of carbapenemase-producing Enterobacteriaceae among high-risk patients from ICU and HSCT wards in a university hospital, Antimicrobial Resistance & Infection Control . 2020, 9, 155. Lin, M. Y.; Ray, M. J.; Rezny, S.; Runningdeer, E.; Weinstein, R. A.; Trick, W. E. Predicting Carbapenem-Resistant Enterobacteriaceae Carriage at the Time of Admission Using a Statewide Hospital Discharge Database, Open Forum Infect Dis . 2019, 6, ofz483. Fernández-Martínez, N. F.; Cárcel-Fernández, S.; De la Fuente-Martos, C., et al. Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit, International journal of environmental research and public health . 2022, 19 . Githii, S.; Maingi, J. M.; Nyaga, T.; Ndungu, C.; Nyongesa, K. W.; Musyoki, A. M. Gastrointestinal carriage of carbapenemase-producing enterobacterales among inpatient and outpatient children in Kenya, Scientific reports . 2024, 14, 30684. Tian, F.; Li, Y.; Wang, Y., et al. Risk factors and molecular epidemiology of fecal carriage of carbapenem resistant Enterobacteriaceae in patients with liver disease, Annals of clinical microbiology and antimicrobials . 2023, 22, 10. Kiros, T.; Belete, D.; Andualem, T., et al. Carriage of β-lactamase and carbapenemase-producing Enterobacteriaceae in hospitalized patients at debre tabor comprehensive specialized hospital, Heliyon . 2023, 9, e20072. Lin, M. Y.; Ray, M. J.; Rezny, S., et al. Predicting Carbapenem-Resistant Enterobacteriaceae Carriage at the Time of Admission Using a Statewide Hospital Discharge Database, Open Forum Infectious Diseases . 2019, 6 . Additional Declarations No competing interests reported. Supplementary Files APPENDIX1.docx Cite Share Download PDF Status: Published Journal Publication published 31 Oct, 2025 Read the published version in BMC Infectious Diseases → Version 1 posted Editorial decision: Revision requested 08 Sep, 2025 Reviews received at journal 07 Sep, 2025 Reviews received at journal 06 Sep, 2025 Reviewers agreed at journal 03 Sep, 2025 Reviews received at journal 23 Aug, 2025 Reviewers agreed at journal 12 Aug, 2025 Reviewers agreed at journal 12 Aug, 2025 Reviewers agreed at journal 11 Aug, 2025 Reviewers agreed at journal 10 Aug, 2025 Reviewers agreed at journal 10 Aug, 2025 Reviewers invited by journal 10 Aug, 2025 Editor assigned by journal 10 Aug, 2025 Editor invited by journal 05 Aug, 2025 Submission checks completed at journal 04 Aug, 2025 First submitted to journal 04 Aug, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7223251","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":499473276,"identity":"6a697562-8ae0-4a67-9bf5-a210cf8d159a","order_by":0,"name":"Yahaya Yaqub","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA9UlEQVRIiWNgGAWjYJACZiBOAGLGB0CCh48ULcwGIC1spGhhkwDxCGoxOH54m3Rhm10e/4zkZ5Vfc+xk2BiYHz66gU/LmbQy6ZltycUSN9LMbstuSwY6jM3YOAeflgM5ZtK8bcyJDTcSzG5LbmMGauFhk8ar5fwbkJb6xPk30r8VS26rJ0LLDbAthxM3ABmMH7cdJqxF8sazYusZ544nbjzzpliacdtxHjZmAn7hO5+88XZBWXXivOPpGz/+3FZtz8/e/PAxPi0KBxgMGBhBcSGQwMDMAxJixqMcBOQbgFoY/gBZ/AcYGH8QUD0KRsEoGAUjEwAAOu5LV0nWzJ0AAAAASUVORK5CYII=","orcid":"","institution":"Ahmadu Bello University Zaria","correspondingAuthor":true,"prefix":"","firstName":"Yahaya","middleName":"","lastName":"Yaqub","suffix":""},{"id":499473281,"identity":"2ac969e0-da6b-4f73-997e-c233143a5f3b","order_by":1,"name":"Yusuf Muhammed","email":"","orcid":"","institution":"Bayero University Kano","correspondingAuthor":false,"prefix":"","firstName":"Yusuf","middleName":"","lastName":"Muhammed","suffix":""},{"id":499473284,"identity":"8859f3ca-bc32-4364-bfe6-d238f595e29c","order_by":2,"name":"Bishir Musa","email":"","orcid":"","institution":"Ahmadu Bello University Zaria","correspondingAuthor":false,"prefix":"","firstName":"Bishir","middleName":"","lastName":"Musa","suffix":""},{"id":499473286,"identity":"33e66c63-2086-42e4-bf65-96a683c4c772","order_by":3,"name":"Zainab Rabilu Daninna","email":"","orcid":"","institution":"Bayero University Kano","correspondingAuthor":false,"prefix":"","firstName":"Zainab","middleName":"Rabilu","lastName":"Daninna","suffix":""},{"id":499473288,"identity":"8f91cb63-051b-43e5-89cd-87e628af1336","order_by":4,"name":"Muhammad Sani Aliyu","email":"","orcid":"","institution":"Ahmadu Bello University Zaria","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"Sani","lastName":"Aliyu","suffix":""},{"id":499473291,"identity":"a805a9db-760c-401b-bf3d-b8f85bb6338e","order_by":5,"name":"Zainab Lamido Tanko","email":"","orcid":"","institution":"Kaduna State University","correspondingAuthor":false,"prefix":"","firstName":"Zainab","middleName":"Lamido","lastName":"Tanko","suffix":""},{"id":499473295,"identity":"dab4130e-4008-409a-a6f2-8b4b2eb272c4","order_by":6,"name":"Muhammad Shuaibu","email":"","orcid":"","institution":"Federal University Dutse","correspondingAuthor":false,"prefix":"","firstName":"Muhammad","middleName":"","lastName":"Shuaibu","suffix":""},{"id":499473296,"identity":"845bdee1-53f2-40e2-8867-b53b2ea22548","order_by":7,"name":"Rabiu Ibrahim Jalo","email":"","orcid":"","institution":"Bayero University Kano","correspondingAuthor":false,"prefix":"","firstName":"Rabiu","middleName":"Ibrahim","lastName":"Jalo","suffix":""},{"id":499473297,"identity":"b509201c-3062-404a-b861-3a3d839866b6","order_by":8,"name":"Aliyu Aminu","email":"","orcid":"","institution":"Bayero University Kano","correspondingAuthor":false,"prefix":"","firstName":"Aliyu","middleName":"","lastName":"Aminu","suffix":""},{"id":499473300,"identity":"35e67b44-2249-4125-ac93-3ace16b80b25","order_by":9,"name":"Abubakar Jibril","email":"","orcid":"","institution":"Federal University of Health Sciences Azare","correspondingAuthor":false,"prefix":"","firstName":"Abubakar","middleName":"","lastName":"Jibril","suffix":""},{"id":499473301,"identity":"89cbb101-2aba-4f16-a643-22ccf898aeda","order_by":10,"name":"Amina Ibrahim Braji","email":"","orcid":"","institution":"Northwest University Kano","correspondingAuthor":false,"prefix":"","firstName":"Amina","middleName":"Ibrahim","lastName":"Braji","suffix":""},{"id":499473302,"identity":"98ef35a8-4428-4313-abd6-ab9b2abd979e","order_by":11,"name":"Yahaya Mohammed","email":"","orcid":"","institution":"Usmanu Danfodiyo University Sokoto","correspondingAuthor":false,"prefix":"","firstName":"Yahaya","middleName":"","lastName":"Mohammed","suffix":""}],"badges":[],"createdAt":"2025-07-26 21:23:09","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7223251/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7223251/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12879-025-11944-w","type":"published","date":"2025-10-31T15:56:56+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":95039883,"identity":"20de81d1-95a3-4bcf-8192-8c638e32787a","added_by":"auto","created_at":"2025-11-03 16:05:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1965443,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7223251/v1/4e175f0e-62e3-4c37-80b1-f1d409ed9563.pdf"},{"id":89100625,"identity":"cce97bb0-02ca-4e99-b880-c96c55b371a6","added_by":"auto","created_at":"2025-08-14 16:09:06","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":22110,"visible":true,"origin":"","legend":"","description":"","filename":"APPENDIX1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7223251/v1/9ae0f2dbd588144d6738ecfc.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risk factors associated with rectal carriage of carbapenem resistant Enterobactorales in northern Nigeria: A hospital surveillance","fulltext":[{"header":"Introduction","content":"The description of antibiotic resistance by bacteria was first towards single agent but these resistance pattern has since changed to been exhibited towards many agents of different classes and modes of action.1 Various mechanisms of antibiotic resistance have been described but production of enzymes that hydrolyse the agent is most frequently utilized against the beta-lactam group of antibiotics. These enzymes are collectively called the beta-lactamases and importantly include the carbapenemases.2 The clinical report of carbapenemases producing Enterobacterales (CPE) in 1993 was a major setback to the already established problem of antibiotic resistance.3 Carbapenamases have long been reported to be transferable on plasmids which makes them highly among the Enterobacterales.4 As Enterobacterales are commensals of the gut, this site provides them with a haven which they use to transit between the hospital and the community.5-7\nThe Centre for Disease Control and Prevention (CDC) and European Centre for Disease Prevention and Control (ECDC) classified bacterial pathogens into; Multidrug-resistance (MDR) to organisms showing in-vitro resistance to one antibiotic agent in three or more antibiotic classes, extensively drug-resistance (XDR) to those showing susceptibility to only one or two categories and Pan drug-resistance (PDR) to those showing susceptibility to no agent in any category.8 The CPE were put in the MDR class although this is not exclusive and has being described in virtually all known pathogenic.9 Recently, CRE were listed in the “critical category” of the World Health Organization (WHO) bacterial priority pathogens, highlighting the impact of these pathogens on global health currently and the foreseeable future.10\nInitially resistant Enterobacterales were more often associated with hospitalized patient and the hospital environment arguably due to the constant interaction between these organisms and the use of different antibiotics in the hospital.6, 11, 12 Reports of recovery from MDRO’s from community sewages further consolidates the intestinal origin of these organisms which adds to the already established hand carriage.13-15 A wider epidemiological fact is that these MDROs show a geographically describable globally.16 CPE were reported to account for between 2-7% of infection in USA, Europe, and Asia among ICU patients while up to 25% Klebsiella spp isolates has been reported show carbapenem resistance in Greece.2 However, in Nigeria there have been reports of CPE isolates from clinical from Kano,17, 18 Abeokuta19 and Lagos.20 A systematic review recently reported that the increase of resistance to carbapenem was seen the most compared to other antibiotics among Gram negative bacteria. Also, the review proposed that about 92 million deaths projected (i.e. across all age groups) to be attributable to AMR between 2025 and 2030, could be averted through provision of better care for sever infections and improved access to antibiotics.21 Infections by MDROs have been associated with a delay in initiation of appropriate therapy, long hospital stay, increased medical bill and a high mortality.22 There is however, a dearth a research in the area of rectal surveillance from this Nigeria.\nIt was our ardent hope that this study adds an objective appreciation of the magnitude of CPE rectal carriage problem among in-patients during the period just preceding the recent COVID-19 pandemic. The objectives of this study were; 1. To determine the prevalence of faecal colonization by CPE among in-patients, 2. To determine the risk factors associated with faecal colonization by CRE among in-patients, and 3. To appreciate which risk factors are independently associated with faecal colonization by CPE among in-patients.\n"},{"header":"Methods","content":"\u003ch2\u003eStudy area\u003c/h2\u003e\n\u003cp\u003eThis study was carried out at Ahmadu Bello University Teaching Hospital (ABUTH) Zaria, Kaduna state in the North-western region of Nigeria. The hospital is a tertiary health centre with a 1,000-bed capacity. As a referral health facility, it receive about 10,000 patients visit the facility each year from all parts of the country.\u003c/p\u003e\n\u003ch2 id=\"_Toc150888286\"\u003eStudy design\u003c/h2\u003e\n\u003cp\u003eThis was a cross-sectional study to describe the association of risk factors and rectal CRE carriage among hospitalised patients at ABUTH Zaria. It involved an interviewer administered questionnaire followed by rectal swab sample collection from participants in the following wards; (medical, surgical, paediatrics, gynaecology and oncology), Intensive Care Unit (ICU) and Special Care Baby Unit (SCBU). These samples were processed at the medical microbiology laboratory of ABUTH, Zaria.\u003c/p\u003e\n\u003ch2 id=\"_Toc150888287\"\u003eSample size calculation\u003c/h2\u003e\n\u003cp\u003eCross-sectional sample size calculator on Epi info 7 was used with the following parameters; power of 80%, two-sided confidence interval of 95% and expected outcome in the unexposed was 11% (from a similar study \u003csup\u003e23\u003c/sup\u003e). The total sample size of 168 was arrived at for the Kelsey\u0026rsquo;s method.\u003c/p\u003e\n\u003ch2 id=\"_Toc150888288\"\u003eInclusion criteria\u003c/h2\u003e\n\u003cp\u003ePatients who were admitted into the medical, surgical, paediatrics, gynaecology, oncology, ICU and SCBU.\u003c/p\u003e\n\u003ch2 id=\"_Toc150888289\"\u003eExclusion criteria\u003c/h2\u003e\n\u003cp\u003ePatients who either had a colostomy or were on dialysis were excluded from this study.\u003c/p\u003e\n\u003ch2 id=\"_Toc150888290\"\u003eSampling technique\u003c/h2\u003e\n\u003cp id=\"_Toc150888292\"\u003eThe sample size of 168 was divided across the seven units equally leading to recruitment of twenty-four patients in each unit. Patients on odd numbered beds were recruited during a single visit. Subsequently new patients were enrolled if they were on odd numbered beds. This process continued until the sample size was reached. However, all patients from the ICU and SCBU were recruited in a non-repetitively fashion due to the scarcity of patients. Patients\u0026rsquo; recruitment and rectal sab laboratory processing was between January 2017 and November 2017 (i.e. 10 months).\u003c/p\u003e\n\u003ch2\u003eData collection tools\u003c/h2\u003e\n\u003cp\u003eThis involved an interviewer administered questionnaire followed by rectal swab collection.\u003c/p\u003e\n\u003ch3\u003eQuestionnaire\u003c/h3\u003e\n\u003cp\u003eA questionnaire, designed for this study, was used to collect information on the thirty-three associated risk factors of interest (See appendix 1). These risk factors were divided into four section i.e. 1. Demographic risk factors (e.g. age, sex, education, etc); 2. Environmental risk factors (e.g place of residence, living with animals, toilet facility, etc); 3. Current hospital risk factors (ward, length of stay, antibiotic use, etc); 4. Past hospital risk factors (e.g. Previous hospital admission in Nigeria within the past 1 year, Length of hospital stay in Nigeria within the past 1 year, Previous hospital admission outside Nigeria within the past 1 year, etc. The outcome of interest was the rectal carriage of CRE.\u003c/p\u003e\n\u003ch3 id=\"_Toc150888293\"\u003eRectal swab sample collection and processing\u003c/h3\u003e\n\u003cp\u003eA labelled rectal swab was collected with an Amies transport swab,\u003cem\u003e.\u003c/em\u003e\u003csup\u003e24\u003c/sup\u003e from all participants in this study. The rectal swab sample was collected, transported to the lab, then Gram negative bacterial isolation, screening and confirmation for CRE and molecular characterization done as described by Yaqub et al.\u003csup\u003e25\u003c/sup\u003e\u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc533363197\"\u003eData analysis\u003c/h2\u003e\n\u003cp\u003eData from each participant was entered into and cleaned in Excel spreadsheet. Binary entries were coded as 1= yes and 0= no while ordinal categorical entries were coded as 1, 2, 3 etc. Continuous data (i.e. \u0026ldquo;age (days)\u0026rdquo; and \u0026ldquo;length of hospital stay\u0026rdquo;) were stratified appropriately into weeks while \u0026ldquo;age (years)\u0026rdquo; was stratified into decades i.e. 1-10, 11-20 etc. All statistical analyses were done in Stata 14 (StataCorp LP, College Station, USA). Two-sided p-values (\u003cu\u003e\u0026lt;\u003c/u\u003e0.05) and confidence intervals (CI) of 95% were used for significance testing in this study. Prevalence of CRE rectal carriage was determined for the study. A Pearson chi-square (X\u003csup\u003e2\u003c/sup\u003e) test (i.e. 2-sided value) was used to check for association between CRE rectal carriage and information on risk factors (i.e. variables) collected in the questionnaire. Odds ratio (OR) was calculated for these associations to check for strength and nature of the variables to CRE rectal carriage. Logistic regression analyses were conducted to control for the confounding effects of the significantly associated risk factors observed in the study. All p values for this study were two-sided and p\u0026le;0.05 was considered significant. All CIs were 95% and were only considered good if they did not include the null figure (i.e. 0 for \u0026chi;2 tests and 1 for OR) and not wide from the observed values.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eThe prevalence of rectal carriage of CRE was 4.2% (N=168). The distribution of isolates in this study were \u003cem\u003eE. coli\u003c/em\u003e (83%), \u003cem\u003eKlebsiella pneumoniae\u003c/em\u003e (15%) and \u003cem\u003eEnterobacter aerogenes\u003c/em\u003e (2%). All CRE (n=7) were \u003cem\u003eKlebsiella pneumonia\u0026nbsp;\u003c/em\u003e(n=22).\u003c/p\u003e\n\u003ch2\u003eDescriptive statistics of risk factors for rectal carriage of CRE\u003c/h2\u003e\n\u003cp\u003eThe ages of participants in SCBU were categorized into 1\u003csup\u003est\u003c/sup\u003e through 4\u003csup\u003eth\u003c/sup\u003e week of life and for other participants, the ages were in years and thus categorized into decades i.e. 1-10, 11-20, etc. There was an increasing proportion of CRE carriage among participants with every increase in decade and the pooling of this finding was in those \u0026gt;60 years. The current or past history length of hospital stay (in \u0026ldquo;days\u0026rdquo;) of the participants i.e., within and outside Nigeria in the past year, were categorised into weeks and a relationship appeared to exist with rectal carriage of CRE. Educational status of the participants appeared to affect rectal carriage of CRE in a decreasing manner with increasing educational exposure. Complete results on demographic risk factors can be found in Table 1.\u003c/p\u003e\n\u003cp\u003eThere was an almost equal distribution for rectal carriage of CRE irrespective of the type of residence the participants lived in or their toilet facility. The proportion of CRE carriage was highest in those who drank borehole water (16.7%, n=6). Detailed results on environmental risk factors can be found in Table 2.\u003c/p\u003e\n\u003cp\u003eCRE carriage was found in ICU and SCBU at 20.8% and 8.3% respectively. There was an increasing proportion of CRE carriage with every increase in week of hospital admission. Other risk factors on \u0026ldquo;current hospital admission\u0026rdquo; can be found in\u0026nbsp;Table 3.\u003c/p\u003e\n\u003cp\u003eThose with a history of previous admission in Nigeria were near in proportion to those with no such history 75% and 88.5% respectively. However all those who had a history of admission outside Nigeria did not carry ESBL-PE (n=3). Other past hospital risk factors can be found in\u0026nbsp;Table 4.\u003c/p\u003e\n\u003ch2\u003eEvidence of the existence of association between risk factors and rectal CRE carriage\u003c/h2\u003e\n\u003cp\u003eThe ward a patient was admitted into had a very strong association with CRE carriage (\u003cstrong\u003eX\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e=22.9, p=0.001). However age was quite significantly associated with CRE carriage only in adult patients (\u003cstrong\u003eX\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e13.0, p=0.07). The present length of hospital stay (\u003cstrong\u003eX\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e=12.7, p=0.03) and educational status (\u003cstrong\u003eX\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e=7.6, p=0.06) were also associated with CRE carriage. The working diagnosis, i.e. whether an infectious or not, (\u003cstrong\u003eX\u003csup\u003e2\u0026nbsp;\u003c/sup\u003e\u003c/strong\u003e0.2, p=0.64) was not associated with CRE carriage. (See Table 5).\u003c/p\u003e\n\u003ch2\u003eStrength of the observed association of risk factors to rectal CRE carriage\u003c/h2\u003e\n\u003cp\u003eThe ward a patient was admitted was significantly associated with CRE carriage and wasn\u0026rsquo;t due to chance (OR 1.5, CI 1.03 - 2.19, p=0.03). Every decade increase in patients\u0026rsquo; age was also found to significantly increase the risk of CRE carriage (OR 1.79, CI 1.13 - 2.84, p=0.01). Marital status though was found to marginally increase the risk of CRE carriage, this association may have been due to chance (OR 1.1, CI 0.29 - 4.15, p=0.9). Present hospital admission though was associated with CRE carriage, the increased risk associated with it may have been due to chance as well (OR 1.7, CI 0.90 - 2.99, p=0.1). (See Table 6).\u003c/p\u003e\n\u003ch2\u003eIndependence of association between risk factors and rectal CRE carriage\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eA logistic regression revealed that the risk of CRE carriage doubled for the ward a patient was admitted into after controlling for the confounding effect of other associated variables (unadjusted OR 1.5 \u0026amp; adjusted OR 3.1, CI 1.14 - 8.20, p=0.03). Also the risk posed by present hospital admission on CRE carriage more than doubled as well (unadjusted OR 1.7 \u0026amp; adjusted OR 3.9, p=0.03, CI 1.12 \u0026ndash; 13.49). There was a reduction in the protection from CRE carriage a patient enjoyed due to young age once the confounding effect of other important risk factors were controlled for remarkably however is that this protection was not due to chance (unadjusted OR 1.8 \u0026amp; adjusted OR 0.2, p=0.47, CI 0.04 - 0.98). (See Table 7).\u003c/p\u003e\n\u003cp\u003eThe educational status of the participant was protective from the crudes odds ratio (Unadjusted OR=0.2, p=0.0103, CI 0.06 - 0.69). This protective effect was not affected despite controlling for other risk increasing variables through a univariate analysis (ORs were around 0.2, p values were \u0026lt; 0.05 \u0026amp; CIs did not contain 1). However, once more than one variable was controlled for simultaneously (i.e. multivariate analysis) the observed ORs turned out be due to chance (p values were \u0026gt; 0.05 \u0026amp; CIs contained 1). (See Table 8).\u003c/p\u003e\n\u003cp id=\"_Toc1317891\"\u003eTable\u0026nbsp;1: Description of participants\u0026rsquo; demographic risk factors for rectal carriage of CRE.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProportion of CRE n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (SCBU in days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en=24\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e1\u003csup\u003est\u003c/sup\u003e week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e2/7 (28.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e2\u003csup\u003end\u003c/sup\u003e week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/9 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e3\u003csup\u003erd\u003c/sup\u003e week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/6 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e4\u003csup\u003eth\u003c/sup\u003e week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/2 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge (Adults in years)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003en=144\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e1-10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/22 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e11-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/2 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e21-30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/23 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e31-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e1/28 (3.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e41-50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/25 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e51-60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e1/26 (3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e61-70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e2/14 (14.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e71-80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e1/4 (25)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003emale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e5/71 (7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e2/97 (2.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTribe\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003eHausa\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e5/96 (5.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003eIgbo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/11 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003eYoruba\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e1/12 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e1/49 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e2/60 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e5/103 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/2 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 34.0799%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0678%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0678%;\"\u003e\n \u003cp\u003eTrader\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e2/27 (7.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0678%;\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e5/119 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0678%;\"\u003e\n \u003cp\u003eCivil Servant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/22 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0678%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0678%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0678%;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e2/10 (20)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0678%;\"\u003e\n \u003cp\u003ePrimary or Islamic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e1/14 (7.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0678%;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e4/131 (3.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 35.0678%;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65.6903%;\"\u003e\n \u003cp\u003e0/13 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc1317892\"\u003eTable\u0026nbsp;2: Description of participants\u0026rsquo; environmental risk factors for rectal carriage of CRE.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProportion of CRE n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePlace of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eKaduna\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e6/113 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNorthwest States\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1/30 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eOther northern States\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e0/19 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eOther parts of Nigeria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e0/6 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eType of residence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eIndividual house\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1/31 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eShared compound\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e6/137 (4.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLiving with Animals\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e6/123 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1/45 (2.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWater source\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eWell or spring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e5/103 (4.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003ePublic tap\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1/59 (1.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003ePrivate borehole\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1/6 (16.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eToilet facility\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eShared with public\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e4/124 (3.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003eOpen defaecation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e1/19 (5.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003ePrivate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50%;\"\u003e\n \u003cp\u003e2/25 (8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc1317893\"\u003eTable\u0026nbsp;3: Description of participants\u0026rsquo; current hospital risk factors for rectal carriage of CRE.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"607\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eProportion of CRE n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWards\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003eMedical\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e0/24 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003eSurgical\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e0/24 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003eGynaecology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e0/24 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003eOncology\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e0/24 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003eICU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e5/24 (20.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003ePaediatrics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e0/24 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003eSCBU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e2/24 (8.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWorking diagnosis\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003eInfectious\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e7/163 (4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003enon-infectious diseases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e0/5 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital stay(days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e1\u003csup\u003est\u003c/sup\u003e week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e1/73 (1.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e2\u003csup\u003end\u003c/sup\u003e week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e2/44 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e3\u003csup\u003erd\u003c/sup\u003e week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e3/25 (12)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e4\u003csup\u003eth\u003c/sup\u003e week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e0/17 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e5\u003csup\u003eth\u0026nbsp;\u003c/sup\u003eweek\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e0/6 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e6\u003csup\u003eth\u003c/sup\u003e week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e1/3 (33.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotic use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e168/168 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeta-lactam use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e168/168 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther antibiotic use\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eN=168\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e7/154 (4.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e0/14 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 50.1235%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49.8765%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc1317894\"\u003eTable\u0026nbsp;4: Description of participants\u0026rsquo; past hospital risk factors for rectal carriage of CRE\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\u003cbr\u003e\u003cstrong\u003eProportion for CRE N=168 (%)\u003c/strong\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious hospital admission in Nigeria within the past 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/12 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e7/156 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital stay in past year in Nigeria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e7/156 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e1 week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u0026nbsp;0/3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e2 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/6 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e3 weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotic use in Nigeria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/12 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e7/156 (4.5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeta-lactam use in Nigeria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/12 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e7/156 (4.5)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther antibiotic use in Nigeria\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/11 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e7/157 (4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePrevious hospital admission outside Nigeria in the past 1 year\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e7/165 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital stay in past year outside Nigeria (days)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e7/165 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e14 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e22 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e27 days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/1 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAntibiotic use outside\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e7/165 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eBeta-lactam use outside\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e7/165 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOther antibiotic use outside\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e0/3 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 37.4359%;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 62.5641%;\"\u003e\n \u003cp\u003e7/165 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc1317897\"\u003eTable 5: Evidence of the existence of association between some risk factors and rectal carriage of CRE.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eX\u003csup\u003e2\u003c/sup\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eWard\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e22.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eAge_days (SCBU)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e5.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e0.151\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge_years (Others)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e13.02\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.072\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e*Marital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e6.9\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.072\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLength of hospital stay (present)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e12.7\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.027\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e7.6\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.056\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eWorking diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e0.636\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eHaving diarrhoea\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e2.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e0.111\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 229px;\"\u003e\n \u003cp\u003eTribe\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 172px;\"\u003e\n \u003cp\u003e1.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e0.612\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003eSee full table of risk factor associations with CRE faecal colonization in \u003cstrong\u003eSupplemental Table.\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e\n\u003cp id=\"_Toc1317898\"\u003eTable 6: The strength of association between rectal carriage of CRE and significant risk factors.\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds Ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatients\u0026rsquo; ward\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.5\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0342\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.03 - 2.19\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient\u0026rsquo;s Age years\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.79\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0132\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e1.13 - 2.84\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eMarital status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e1.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e0.8878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e0.29 - \u0026nbsp;4.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.2\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.0103\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.06 - 0.69\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eLength of hospital stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 143px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 146px;\"\u003e\n \u003cp\u003e0.1031\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 136px;\"\u003e\n \u003cp\u003e0.90 - 2.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc1317899\"\u003eTable 7: Logistic regression showing the nature of association between significant risk factors (dependent variables) and rectal carriage of CRE after controlling for the confounding effect other significant variables.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"631\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDependent variable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControlled\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUnadjusted OR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAdjusted\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eOR\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003ePatients\u0026rsquo; age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eEducational status, length of hospital stay and ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.04 - 0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eLength of hospital stay (present)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eWard, Educational status and age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e3.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1.12 - 13.49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003ePatients\u0026rsquo; ward\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003eEducational status, age (years) and length of hospital stay\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e3.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 105px;\"\u003e\n \u003cp\u003e1.14 - 8.20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp id=\"_Toc1317900\"\u003eTable 8: The protective effect (i.e. bivariate and multivariate analysis) of educational status on rectal CRE carriage after adjusting for other variables.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControlled\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOdds ratio\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eP value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePatients\u0026rsquo; ward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.0077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.05 - 0.63\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eLength of hospital stay in Nigeria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.0185\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.06 - 0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.0227\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.08 - 0.83\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePatients\u0026rsquo; ward and age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.0176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.06 - 0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003eLength of hospital stay in Nigeria and age (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.0768\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.11 - 1.12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePatients\u0026rsquo; ward and length of hospital stay in Nigeria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.0911\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.06 - 1.23\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003ePatients\u0026rsquo; ward, age (years) and length of hospital stay in Nigeria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.1573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0.09 - 1.47\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cem\u003e(Unadjusted OR=0.2, p=0.0103, CI 0.06 - 0.69)\u003c/em\u003e\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe prevalence rectal carriage of CRE was 4.2% (N\u0026thinsp;=\u0026thinsp;168) in this study. This was slightly different from that from an earlier study with similar design but smaller sample size (n\u0026thinsp;=\u0026thinsp;77) in Morocco which found a higher CRE (10%) rectal colonisation (CI -0.66% 14.77%, p\u0026thinsp;=\u0026thinsp;0.08).\u003csup\u003e26\u003c/sup\u003e However, a cohort study with a bigger sample size found a CRE rectal colonization rate of 10.0% (n\u0026thinsp;=\u0026thinsp;330) which not statistically different from that observer in this study (CI 1.59% \u0026minus;\u0026thinsp;11.08%, p\u0026thinsp;=\u0026thinsp;0.011).\u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe demographic risk factors of significance were age and educational status. From Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e above, the first week of life for patients in the SCBU appeared to particularly expose patient to rectal carriage of CRE but had no evidence of statistical association (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;5.2, p\u0026thinsp;=\u0026thinsp;0.151) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e. For other participants however, there was an increasing proportion of CRE rectal colonization through every increase in decade of life with a pool of findings in the \u0026gt;\u0026thinsp;60 year olds with some association (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;13, p\u0026thinsp;=\u0026thinsp;0.07). The apparent increasing odds ratio (unadjusted OR\u0026thinsp;=\u0026thinsp;1.8) with every increase in the decade of life associated with rectal carriage of CRE, disappeared once the effect of other significant risk factors (i.e. patient\u0026rsquo;s ward, length of hospital stay and educational status) were controlled for (adjusted OR\u0026thinsp;=\u0026thinsp;0.2, CI 0.04\u0026ndash;0.98, p\u0026thinsp;=\u0026thinsp;0.047) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e. Thus once the effect of ward and length of hospital stay were controlled for, the OR of age dropped significantly and CI widened. As such it can be inferred that the age of patient is an independent protective factor for rectal carriage of CRE if patients are not admitted into critical wards (ICU and SCBU). A recent study in the south-western city (i.e. Ibadan) in Nigeria found a similarly high burden in the latter decades of life.\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e A recent systematic review reported age (i.e. \u0026gt;5 years) as an important factor for the increase in death associated with antibiotic resistant pathogens.\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAlthough female participants were slightly more than males in this study (i.e. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), males had a higher rectal carriage of CRE but this may have been due to chance (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;2.6, p\u0026thinsp;=\u0026thinsp;0.111). Attempts to find credible corroborating evidence on the role of gender (i.e. sex) on rectal colonization by CRE was futile and this is echoed by the Gautron et al. who argued in favour of a more gender inclusive consideration in AMR surveillance to fill this knowledge gap.\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eMost of the participants had secondary school as their highest level of education (n\u0026thinsp;=\u0026thinsp;131) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. An interesting trend of decreasing proportion was found between CRE rectal colonization and increasing level of education of the participants which had some significant association (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;7.6, p\u0026thinsp;=\u0026thinsp;0.056). Higher education status of participants appeared to be protective against CRE rectal colonization (unadjusted OR\u0026thinsp;=\u0026thinsp;0.2, CI: 0.06\u0026ndash;0.69, p\u0026thinsp;=\u0026thinsp;0.01). An earlier study in Nigeria found a weak association (i.e. p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) with those with secondary education and above as having a higher chance of carrying MDR-\u003cem\u003eE. coli\u003c/em\u003e.\u003csup\u003e\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e\u003c/sup\u003e However, a recent study from Uganda found that there was some protection offered by higher education as observed in this study.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Upon further analysis however, a univariate regression analysis separately controlling for the confounding effect of the \u0026ldquo;exposing\u0026rdquo; factors (i.e. patients\u0026rsquo; ward (OR\u0026thinsp;=\u0026thinsp;0.18, CI: 0.05\u0026ndash;0.63, p\u0026thinsp;=\u0026thinsp;0.008) and length of stay in Nigeria (OR\u0026thinsp;=\u0026thinsp;0.22, CI: 0.06\u0026ndash;0.78, p\u0026thinsp;=\u0026thinsp;0.0185)) on the protection offered against CRE rectal colonization, by higher levels of education, the protective effect was not affected and were not due to chance as shown in Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e. A forward stepwise logistic regression was only significant for the effect of \u0026ldquo;age (years)\u0026rdquo; had in addition to patients\u0026rsquo; ward on the protective effect of increasing level of education (OR\u0026thinsp;=\u0026thinsp;0.21, CI: 0.06\u0026ndash;0.76, p\u0026thinsp;=\u0026thinsp;0.018). Interestingly, adjusting for the any of the other factors (i.e. age (years), patients\u0026rsquo; ward and length of stay in Nigeria) nullified this observed protection offered by education as long as the risk factor \u0026ldquo;length of stay in Nigeria\u0026rdquo; was included as all the confidence intervals included the null figure i.e. 1 (See Table\u0026nbsp;\u003cspan refid=\"Tab8\" class=\"InternalRef\"\u003e8\u003c/span\u003e). Thus it can be inferred that increasing level of education could be protective against CRE rectal colonization if a patient has a short hospital stay and was not admitted into a critical unit (i.e. ICU or SCBU).\u003c/p\u003e\u003cp\u003eMarital status was associated with rectal carriage of CRE (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;6.9, p\u0026thinsp;=\u0026thinsp;0.072) by increasing the odds of rectal colonization by CRE among the married compared to those who are singles, but may be due to chance (OR\u0026thinsp;=\u0026thinsp;1.1, p\u0026thinsp;=\u0026thinsp;0.887, CI 0.29\u0026ndash;4.15). A recent study having a different design (i.e. Knowledge attitude and Practice) found a similar poor association of marital status with antibiotic consumption on the emergence of antibiotic resistance.\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e Although there appeared to be a decreasing proportion of rectal carriage of CRE from traders to farmers to civil servants (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), no association was found with the occupation of the participants (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.7, p\u0026thinsp;=\u0026thinsp;0.435) and this was similar to the findings from a recent study in Uganda.\u003csup\u003e\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e Tribe had no significant association with rectal carriage of CRE (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.8, p\u0026thinsp;=\u0026thinsp;0.612) although the highest CRE carriage was among those who identified as Yoruba (8.3%, n\u0026thinsp;=\u0026thinsp;12) (see Supplementary Table).\u003c/p\u003e\u003cp\u003eAlthough none of the environmental risk factors was found to be statistically significant, all participants with rectal carriage of CRE came from the northwest including Kaduna state, no association was demonstrated statistically (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.5, p\u0026thinsp;=\u0026thinsp;0.680). CRE rectal colonization was found more in those with shared hosing compared with those in individual housing but no association was found (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.08, p\u0026thinsp;=\u0026thinsp;0.772). This is similar to a finding of systematic review that found that most studies they included did not have any significant association.\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e\u003c/sup\u003e The finding that those with \u0026ldquo;private borehole\u0026rdquo; as their type of water source had the highest proportion of CRE carriage was quite surprising. However, a test of association later showed that the type of water source was not significant (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;3.37, p\u0026thinsp;=\u0026thinsp;0.185). A 2023 paper published the findings of a study conducted in a Kenyan Hospital that came to a similar conclusion to that from this study conducted before the COVID pandemic.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e Toilet facility whether private, shared or open defecation had no association with CRE carriage as well (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;1.25, p\u0026thinsp;=\u0026thinsp;0.535) which was similar to that observed from the Kenyan study mention earlier.\u003csup\u003e\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003e The ward a participant was admitted into as well as their length of stay on admission as at the time of conduct of this study, were the risk factors of significance in the \u0026ldquo;current hospital risk factors\u0026rdquo; category. All the participants with rectal carriage of CRE (n\u0026thinsp;=\u0026thinsp;7) were from the critical wards (i.e. ICU and SCBU) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. This observation was found to have a very strong association with CRE faecal colonization (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;23, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). A logistic regression analysis, controlling for other significantly associated variables (i.e. educational status, age (years) and length of hospital stay), revealed that the ward a patient was admitted into had an independent association with CRE rectal colonization evidenced by the doubling odds ratio (unadjusted OR\u0026thinsp;=\u0026thinsp;1.5 \u0026amp; adjusted OR\u0026thinsp;=\u0026thinsp;3.1, CI: 1.14\u0026ndash;8.20, p\u0026thinsp;=\u0026thinsp;0.03) as shown in Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e. ICU patients have been reported to have a higher risk of getting colonised by CRE and subsequently getting infected by these pathogens.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eThe length of hospital stay in Nigeria though collected in days, was categorised into weeks to have better epidemiological meaning as depicted in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. A trend of increasing proportion for rectal carriage of CRE with every increase in week spent on the ward became apparent and this was found to have significant association (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;12.7, p\u0026thinsp;=\u0026thinsp;0.027). Controlling for the effect that other significant risk factors (i.e. age (years), patients\u0026rsquo; ward and education status) led to the odds ratio to more than doubled for length of hospital stay for the patient who had been rectal colonised by CRE (unadjusted OR\u0026thinsp;=\u0026thinsp;1.7 \u0026amp; adjusted OR\u0026thinsp;=\u0026thinsp;3.9, CI: 1.12\u0026ndash;13.49, p\u0026thinsp;=\u0026thinsp;0.03). A prediction model proposed by Lin and colleagues found length of hospital stay to be an independent risk factor for CRE rectal colonization.\u003csup\u003e\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u003c/sup\u003e Similarly, another study showed that length of hospital stay was strongly associated with colonization by multidrug-resistant Gram-negative bacteria.\u003csup\u003e\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAny participant who had a record of infection in the current admission as at the time of this study were put into the \u0026ldquo;infection\u0026rdquo; category of the variable \u0026ldquo;Working diagnosis\u0026rdquo;. This may have contributed to the large number of those with infection (n\u0026thinsp;=\u0026thinsp;163) of whom had CRE carriage. The working diagnosis of the participant was however not associated with rectal CRE carriage (X\u003csup\u003e2\u003c/sup\u003e\u0026thinsp;=\u0026thinsp;0.22, p\u0026thinsp;=\u0026thinsp;0.64) even though all the CRE rectal carrying individuals were in the \u0026ldquo;infection\u0026rdquo; category. The report of rectal carriage of CRE preceeding infections among inpatients has being previously documented but wasn\u0026rsquo;t part of the objectives of this study.\u003csup\u003e\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eAll participants in this study had taken a beta-lactam antibiotic during the current admission and thus had no association. This could highlight the liberal use of beta-lactam antibiotic antibiotics in the context that this study was carried out which could be a contributor to AMR or reflect the lack of a functional antimicrobial stewardship program in our context. A more recent study reported that previous antibiotic use significantly increased the risk of carrying carbapenemase producing \u003cem\u003eEnterobacteriaceae\u003c/em\u003e which is different observation from that of this study.\u003csup\u003e\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\u003cp\u003eHaving travelled abroad for medical attention (with or without antibiotic usage), a relative who went for medical attention outside Nigeria (with or without antibiotic usage) or how long the relative stayed did not have any association with CRE carriage among the participants (see supplemental table). Most of the participants had not been admitted into a hospital in Nigeria in the preceding twelve months but interesting all rectal CRE carriage was in this sub-population of participants. As such, a history of previous admission, how long the admission was or a history of any form of antibiotic use during such admission did not have any association with CRE carriage (see supplemental table). A case-control study carried out around the same time (i.e. 2014/2015) as this study in the Illinois, USA, reported a strong association of CRE carriage with admission in the previous one year.\u003csup\u003e\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDespite the low prevalence of CRE carriage in this study, all were isolated from patients in ICU and SCBU. Critical wards like the ICU and SCBU have been reported from other studies as an important risk factor for the rectal carriage of CRE. Thus it can be inferred that the ward a patient is admitted into and how long the patient stayed in the hospital are independent factors for the carriage of CRE.\u003csup\u003e\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u003c/sup\u003e The length of hospital stay in Nigeria appeared to be an independent factor for colonisation while the level of education had some protective effect on the rectal carriage of CRE. It will be important to keep an eye on the critical units such as ICU and SCBU, as all these MDROs were found there.\u003c/p\u003e\u003cp\u003eAs a follow up data collection wasn\u0026rsquo;t part of this study\u0026rsquo;s design, information on the outcome of the patients (i.e. discharged alive or died) was not collected and such any relationship couldn\u0026rsquo;t be established. However, as this study was conducted in the pre-COVID 19 period, it could serve as a reference to with for future similar studies. Importantly also, further studies would be necessary to appreciate what the nature of these risk factors are to CRE carriage in the post-COVID 19 period.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003e\u003cstrong\u003eCRE:\u0026nbsp; \u0026nbsp;Carbapenem Resistant Enterobacterales \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCPE: \u0026nbsp; \u0026nbsp;Carbapenemases producing Enterobacterales\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLMIC:\u0026nbsp;\u0026nbsp; \u0026nbsp; Low and Medium Income Countries\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCOVID-19: Coronavirus disease\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAMR:\u0026nbsp;\u0026nbsp;Antimicrobial Resistance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eICU: \u0026nbsp;\u0026nbsp;\u0026nbsp;Intensive Care Unit\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSCBU: Special Care Baby Unit\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCDC :\u0026nbsp;\u0026nbsp;Centre for Disease Control and Prevention\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eECDC: European Centre for Disease Prevention and Control\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMDR : \u0026nbsp;Multidrug-resistance\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eXDR: \u0026nbsp;\u0026nbsp;Extensively drug-resistance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePDR :\u0026nbsp;\u0026nbsp;Pan drug-resistance\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWHO: \u0026nbsp;World Health Organization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eABUTH : Ahmadu Bello University Teaching Hospital\u003c/strong\u003e\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u0026nbsp;\u003c/strong\u003eEthical approval in accordance with the Declaration of Helsinki was obtained from the Ahmadu Bello University Teaching Hospital, Zaria Research Ethics Committee (Approval number: ABUTHZ/HREC/T20/2016). Informed consent to participate in the study was obtained from the parents or legal guardians of participants below the age of 16 years. Informed consent to participate in the study was obtained from participants aged 16 years and above.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial number:\u003c/strong\u003e not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e All data supporting the findings of this study are available within the paper and its Supplementary information.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors have no competing interests to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e No financial support was provided relevant to this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions:\u0026nbsp;\u003c/strong\u003eYY, AA, ZLT, and YM conceived and implemented the study. YY, AA, ZLT and YM were responsible for analysis and interpretation of data. YY, ZLT, MSA, BM, and YM were the major contributors to the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u0026nbsp;\u003c/strong\u003eWe appreciate the support of the management, ward staff and participating patients of the Ahmadu Bello University Teaching Hospital who participated in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eHerindrainy, P.; Randrianirina, F.; Ratovoson, R., et al. Rectal Carriage of Extended-Spectrum Beta-Lactamase-Producing Gram-Negative Bacilli in Community Settings in Madagascar, \u003cem\u003ePloS one\u003c/em\u003e. \u003cstrong\u003e2011,\u003cem\u003e 6, \u003c/em\u003e\u003c/strong\u003ee22738.\u003c/li\u003e\n\u003cli\u003eRuppe, E.; Woerther, P. L.; Barbier, F. Mechanisms of antimicrobial resistance in Gram-negative bacilli, \u003cem\u003eAnnals of intensive care\u003c/em\u003e. \u003cstrong\u003e2015,\u003cem\u003e 5, \u003c/em\u003e\u003c/strong\u003e61.\u003c/li\u003e\n\u003cli\u003eNordmann, P.; Gniadkowski, M.; Giske, C. G.; Poirel, L.; Woodford, N.; Miriagou, V. Identification and screening of carbapenemase-producing Enterobacteriaceae, \u003cem\u003eClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases\u003c/em\u003e. \u003cstrong\u003e2012,\u003cem\u003e 18, \u003c/em\u003e\u003c/strong\u003e432-438.\u003c/li\u003e\n\u003cli\u003eQueenan, A. M.; Bush, K. Carbapenemases: the Versatile \u0026beta;-Lactamases, \u003cem\u003eClinical Microbiology Reviews\u003c/em\u003e. \u003cstrong\u003e2007,\u003cem\u003e 20, \u003c/em\u003e\u003c/strong\u003e440-458.\u003c/li\u003e\n\u003cli\u003eGirlich, D.; Bouihat, N.; Poirel, L.; Benouda, A.; Nordmann, P. High rate of faecal carriage of extended-spectrum beta-lactamase and OXA-48 carbapenemase-producing Enterobacteriaceae at a university hospital in Morocco, \u003cem\u003eClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases\u003c/em\u003e. \u003cstrong\u003e2014,\u003cem\u003e 20, \u003c/em\u003e\u003c/strong\u003e350-354.\u003c/li\u003e\n\u003cli\u003eIsendahl, J.; Turlej-Rogacka, A.; Manjuba, C.; Rodrigues, A.; Giske, C. G.; Naucl\u0026eacute;r, P. Fecal Carriage of ESBL-Producing E. coli and K. pneumoniae in Children in Guinea-Bissau: A Hospital-Based Cross-Sectional Study, \u003cem\u003ePloS one\u003c/em\u003e. \u003cstrong\u003e2012,\u003cem\u003e 7, \u003c/em\u003e\u003c/strong\u003ee51981.\u003c/li\u003e\n\u003cli\u003eMoore, A. M.; Patel, S.; Forsberg, K. J., et al. Pediatric Fecal Microbiota Harbor Diverse and Novel Antibiotic Resistance Genes, \u003cem\u003ePloS one\u003c/em\u003e. \u003cstrong\u003e2013,\u003cem\u003e 8, \u003c/em\u003e\u003c/strong\u003ee78822.\u003c/li\u003e\n\u003cli\u003eMerli, M.; Lucidi, C.; Di Gregorio, V., et al. The Spread of Multi Drug Resistant Infections Is Leading to an Increase in the Empirical Antibiotic Treatment Failure in Cirrhosis: A Prospective Survey, \u003cem\u003ePloS one\u003c/em\u003e. \u003cstrong\u003e2015,\u003cem\u003e 10, \u003c/em\u003e\u003c/strong\u003ee0127448.\u003c/li\u003e\n\u003cli\u003eShestov, M.; Ontanon, S.; Tozeren, A. Encyclopedia of bacterial gene circuits whose presence or absence correlate with pathogenicity - a large-scale system analysis of decoded bacterial genomes, \u003cem\u003eBMC genomics\u003c/em\u003e. \u003cstrong\u003e2015,\u003cem\u003e 16, \u003c/em\u003e\u003c/strong\u003e773.\u003c/li\u003e\n\u003cli\u003eSati, H.; Carrara, E.; Savoldi, A., et al. The WHO Bacterial Priority Pathogens List 2024: a prioritisation study to guide research, development, and public health strategies against antimicrobial resistance, \u003cem\u003eThe Lancet Infectious Diseases\u003c/em\u003e. \u003cstrong\u003e2025,\u003cem\u003e \u003c/em\u003e\u003c/strong\u003eDOI 10.1016/S1473-3099(25)00118-5.\u003c/li\u003e\n\u003cli\u003eTeo, J.; Cai, Y.; Tang, S., et al. Risk Factors, Molecular Epidemiology and Outcomes of Ertapenem-Resistant, Carbapenem-Susceptible Enterobacteriaceae: A Case-Case-Control Study, \u003cem\u003ePloS one\u003c/em\u003e. \u003cstrong\u003e2012,\u003cem\u003e 7, \u003c/em\u003e\u003c/strong\u003ee34254.\u003c/li\u003e\n\u003cli\u003eAli Abdel Rahim, K. A.; Ali Mohamed, A. M. Prevalence of Extended Spectrum beta-lactamase-Producing Klebsiella pneumoniae in Clinical Isolates, \u003cem\u003eJundishapur journal of microbiology\u003c/em\u003e. \u003cstrong\u003e2014,\u003cem\u003e 7, \u003c/em\u003e\u003c/strong\u003ee17114.\u003c/li\u003e\n\u003cli\u003eWeisenberg, S. A.; Mediavilla, J. R.; Chen, L., et al. Extended Spectrum Beta-Lactamase-Producing Enterobacteriaceae in International Travelers and Non-Travelers in New York City, \u003cem\u003ePloS one\u003c/em\u003e. \u003cstrong\u003e2012,\u003cem\u003e 7, \u003c/em\u003e\u003c/strong\u003ee45141.\u003c/li\u003e\n\u003cli\u003eBogaerts, P.; Verroken, A.; Jans, B.; Denis, O.; Glupczynski, Y. Global spread of New Delhi metallo-\u0026beta;-lactamase 1, \u003cem\u003eThe Lancet Infectious Diseases\u003c/em\u003e. \u003cstrong\u003e2010,\u003cem\u003e 10, \u003c/em\u003e\u003c/strong\u003e831-832.\u003c/li\u003e\n\u003cli\u003eAbdallah, H. M.; Reuland, E. A.; Wintermans, B. B., et al. Extended-Spectrum \u0026beta;-Lactamases and/or Carbapenemases-Producing Enterobacteriaceae Isolated from Retail Chicken Meat in Zagazig, Egypt, \u003cem\u003ePloS one\u003c/em\u003e. \u003cstrong\u003e2015,\u003cem\u003e 10, \u003c/em\u003e\u003c/strong\u003ee0136052.\u003c/li\u003e\n\u003cli\u003eGarner, M. J.; Carson, C.; Lingohr, E. J.; Fazil, A.; Edge, V. L.; Trumble Waddell, J. An Assessment of Antimicrobial Resistant Disease Threats in Canada, \u003cem\u003ePloS one\u003c/em\u003e. \u003cstrong\u003e2015,\u003cem\u003e 10, \u003c/em\u003e\u003c/strong\u003ee0125155.\u003c/li\u003e\n\u003cli\u003eYusuf, I.; Arzai, A.; Getso, M.; Sherif, A.; Haruna, M. P075: Emergence of carbapenem-resistant enterobacteriaceae in surgical and intensive care units of a hospital with low usage of carbapenem in Kano, North West Nigeria, \u003cem\u003eAntimicrobial Resistance and Infection Control\u003c/em\u003e. \u003cstrong\u003e2013,\u003cem\u003e 2, \u003c/em\u003e\u003c/strong\u003eP75.\u003c/li\u003e\n\u003cli\u003eYusuf, I.; Arzai, A. H.; Haruna, M.; Sharif, A. A.; Getso, M. I. Detection of multi drug resistant bacteria in major hospitals in Kano, North-West, Nigeria, \u003cem\u003eBrazilian journal of microbiology : [publication of the Brazilian Society for Microbiology]\u003c/em\u003e. \u003cstrong\u003e2014,\u003cem\u003e 45, \u003c/em\u003e\u003c/strong\u003e791-798.\u003c/li\u003e\n\u003cli\u003eMotayo, B. O.; Akinduti, P. A.; Adeyakinu, F. A., et al. Antibiogram and plasmid profiling of carbapenemase and extended spectrum Beta-lactamase (ESBL) producing Escherichia coli and Klebsiella pneumoniae in Abeokuta, South western, Nigeria, \u003cem\u003eAfrican Health Sciences\u003c/em\u003e. \u003cstrong\u003e2013,\u003cem\u003e 13, \u003c/em\u003e\u003c/strong\u003e1091-1097.\u003c/li\u003e\n\u003cli\u003eEnwuru, N. V.; Enwuru, C. A.; Ogbonnia, S. O.; Adepoju-Bello, A. A. Metallo-\u0026Beta;-Lactamase Production by Escherichia Coli and Klebsiella Species Isolated from Hospital and Community Subjects in Lagos, Nigeria., \u003cem\u003eNature and Science\u003c/em\u003e. \u003cstrong\u003e2011,\u003cem\u003e 9 \u003c/em\u003e\u003c/strong\u003e1-5.\u003c/li\u003e\n\u003cli\u003eGlobal burden of bacterial antimicrobial resistance 1990-2021: a systematic analysis with forecasts to 2050, \u003cem\u003eLancet\u003c/em\u003e. \u003cstrong\u003e2024,\u003cem\u003e 404, \u003c/em\u003e\u003c/strong\u003e1199-1226.\u003c/li\u003e\n\u003cli\u003eKnudsen, J. D.; Andersen, S. E.; for the Bispebjerg Intervention, G. A Multidisciplinary Intervention to Reduce Infections of ESBL- and AmpC-Producing, Gram-Negative Bacteria at a University Hospital, \u003cem\u003ePloS one\u003c/em\u003e. \u003cstrong\u003e2014,\u003cem\u003e 9, \u003c/em\u003e\u003c/strong\u003ee86457.\u003c/li\u003e\n\u003cli\u003eTorres-Gonzalez, P.; Cervera-Hernandez, M. E.; Niembro-Ortega, M. D., et al. Factors Associated to Prevalence and Incidence of Carbapenem-Resistant Enterobacteriaceae Fecal Carriage: A Cohort Study in a Mexican Tertiary Care Hospital, \u003cem\u003ePloS one\u003c/em\u003e. \u003cstrong\u003e2015,\u003cem\u003e 10, \u003c/em\u003e\u003c/strong\u003ee0139883.\u003c/li\u003e\n\u003cli\u003eLerner, A.; Romano, J.; Chmelnitsky, I.; Navon-Venezia, S.; Edgar, R.; Carmeli, Y. Rectal Swabs Are Suitable for Quantifying the Carriage Load of KPC-Producing Carbapenem-Resistant Enterobacteriaceae, \u003cem\u003eAntimicrobial agents and chemotherapy\u003c/em\u003e. \u003cstrong\u003e2013,\u003cem\u003e 57, \u003c/em\u003e\u003c/strong\u003e1474-1479.\u003c/li\u003e\n\u003cli\u003eYaqub, Y.; Ejembi, J.; Aminu, A., et al. Antibiotic resistance pattern of multidrug-resistant Enterobacterales from a rectal surveillance study in northern Nigeria, \u003cem\u003eInternational health\u003c/em\u003e. \u003cstrong\u003e2025,\u003cem\u003e \u003c/em\u003e\u003c/strong\u003eDOI 10.1093/inthealth/ihaf026.\u003c/li\u003e\n\u003cli\u003eGirlich, D.; Bouihat, N.; Poirel, L.; Benouda, A.; Nordmann, P. High rate of faecal carriage of extended-spectrum \u0026beta;-lactamase and OXA-48 carbapenemase-producing Enterobacteriaceae at a university hospital in Morocco, \u003cem\u003eClinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases\u003c/em\u003e. \u003cstrong\u003e2014,\u003cem\u003e 20, \u003c/em\u003e\u003c/strong\u003e350-354.\u003c/li\u003e\n\u003cli\u003eAdekanmbi, O.; Popoola, O.; Fowotade, A., et al. Prevalence of rectal carbapenem resistant Enterobacterales carriage among patients attending healthcare facilities in Ibadan, Nigeria: a descriptive study, \u003cem\u003eBMC infectious diseases\u003c/em\u003e. \u003cstrong\u003e2024,\u003cem\u003e 24, \u003c/em\u003e\u003c/strong\u003e726.\u003c/li\u003e\n\u003cli\u003eGautron, J. M. C.; Tu Thanh, G.; Barasa, V.; Voltolina, G. Using intersectionality to study gender and antimicrobial resistance in low- and middle-income countries, \u003cem\u003eHealth Policy and Planning\u003c/em\u003e. \u003cstrong\u003e2023,\u003cem\u003e 38, \u003c/em\u003e\u003c/strong\u003e1017-1032.\u003c/li\u003e\n\u003cli\u003eAworh, M. K.; Kwaga, J.; Okolocha, E.; Mba, N.; Thakur, S. Prevalence and risk factors for multi-drug resistant Escherichia coli among poultry workers in the Federal Capital Territory, Abuja, Nigeria, \u003cem\u003ePloS one\u003c/em\u003e. \u003cstrong\u003e2019,\u003cem\u003e 14, \u003c/em\u003e\u003c/strong\u003ee0225379.\u003c/li\u003e\n\u003cli\u003eSalam, M. A.; Al-Amin, M. Y.; Salam, M. T., et al. Antimicrobial Resistance: A Growing Serious Threat for Global Public Health, \u003cem\u003eHealthcare\u003c/em\u003e. \u003cstrong\u003e2023,\u003cem\u003e 11, \u003c/em\u003e\u003c/strong\u003e1946.\u003c/li\u003e\n\u003cli\u003eNdagire, R.; Obuku, E. A.; Segawa, I., et al. Knowledge, attitude, and practices regarding antibiotic use and antimicrobial resistance among urban slum dwellers in Uganda, \u003cem\u003eAntimicrobial Resistance \u0026amp; Infection Control\u003c/em\u003e. \u003cstrong\u003e2025,\u003cem\u003e 14, \u003c/em\u003e\u003c/strong\u003e12.\u003c/li\u003e\n\u003cli\u003eK\u0026ouml;ck, R.; Daniels-Haardt, I.; Becker, K., et al. Carbapenem-resistant Enterobacteriaceae in wildlife, food-producing, and companion animals: a systematic review, \u003cem\u003eClinical Microbiology and Infection\u003c/em\u003e. \u003cstrong\u003e2018,\u003cem\u003e 24, \u003c/em\u003e\u003c/strong\u003e1241-1250.\u003c/li\u003e\n\u003cli\u003eMutuma, C. K.; Maingi, J.; Maina, A. K.; Njeru, J.; Musyoki, A. M. Asymptomatic gastrointestinal carriage of multidrug-resistant carbapenemase-producing Enterobacteriaceae among children under five years in a Kenyan hospital, \u003cem\u003eIJID Regions\u003c/em\u003e. \u003cstrong\u003e2023,\u003cem\u003e 9, \u003c/em\u003e\u003c/strong\u003e25-31.\u003c/li\u003e\n\u003cli\u003eYan, L.; Sun, J.; Xu, X.; Huang, S. Epidemiology and risk factors of rectal colonization of carbapenemase-producing Enterobacteriaceae among high-risk patients from ICU and HSCT wards in a university hospital, \u003cem\u003eAntimicrobial Resistance \u0026amp; Infection Control\u003c/em\u003e. \u003cstrong\u003e2020,\u003cem\u003e 9, \u003c/em\u003e\u003c/strong\u003e155.\u003c/li\u003e\n\u003cli\u003eLin, M. Y.; Ray, M. J.; Rezny, S.; Runningdeer, E.; Weinstein, R. A.; Trick, W. E. Predicting Carbapenem-Resistant Enterobacteriaceae Carriage at the Time of Admission Using a Statewide Hospital Discharge Database, \u003cem\u003eOpen Forum Infect Dis\u003c/em\u003e. \u003cstrong\u003e2019,\u003cem\u003e 6, \u003c/em\u003e\u003c/strong\u003eofz483.\u003c/li\u003e\n\u003cli\u003eFern\u0026aacute;ndez-Mart\u0026iacute;nez, N. F.; C\u0026aacute;rcel-Fern\u0026aacute;ndez, S.; De la Fuente-Martos, C., et al. Risk Factors for Multidrug-Resistant Gram-Negative Bacteria Carriage upon Admission to the Intensive Care Unit, \u003cem\u003eInternational journal of environmental research and public health\u003c/em\u003e. \u003cstrong\u003e2022,\u003cem\u003e 19\u003c/em\u003e\u003c/strong\u003e.\u003c/li\u003e\n\u003cli\u003eGithii, S.; Maingi, J. M.; Nyaga, T.; Ndungu, C.; Nyongesa, K. W.; Musyoki, A. M. Gastrointestinal carriage of carbapenemase-producing enterobacterales among inpatient and outpatient children in Kenya, \u003cem\u003eScientific reports\u003c/em\u003e. \u003cstrong\u003e2024,\u003cem\u003e 14, \u003c/em\u003e\u003c/strong\u003e30684.\u003c/li\u003e\n\u003cli\u003eTian, F.; Li, Y.; Wang, Y., et al. Risk factors and molecular epidemiology of fecal carriage of carbapenem resistant Enterobacteriaceae in patients with liver disease, \u003cem\u003eAnnals of clinical microbiology and antimicrobials\u003c/em\u003e. \u003cstrong\u003e2023,\u003cem\u003e 22, \u003c/em\u003e\u003c/strong\u003e10.\u003c/li\u003e\n\u003cli\u003eKiros, T.; Belete, D.; Andualem, T., et al. Carriage of \u0026beta;-lactamase and carbapenemase-producing Enterobacteriaceae in hospitalized patients at debre tabor comprehensive specialized hospital, \u003cem\u003eHeliyon\u003c/em\u003e. \u003cstrong\u003e2023,\u003cem\u003e 9, \u003c/em\u003e\u003c/strong\u003ee20072.\u003c/li\u003e\n\u003cli\u003eLin, M. Y.; Ray, M. J.; Rezny, S., et al. Predicting Carbapenem-Resistant Enterobacteriaceae Carriage at the Time of Admission Using a Statewide Hospital Discharge Database, \u003cem\u003eOpen Forum Infectious Diseases\u003c/em\u003e. \u003cstrong\u003e2019,\u003cem\u003e 6\u003c/em\u003e\u003c/strong\u003e.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"CRE Risk factors, Antimicrobial resistance, Epidemiological surveillance, COVID-19, LMIC, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-7223251/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7223251/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCarbapenem resistant Enterobacterales (CRE) are important cause of antimicrobial resistance (AMR). AMR is a global problem that disproportionately affects the low and middle income countries (LMIC) more. Appreciating what these risk factors were before the recent COVID-19 epidemic would help appreciate what changes have happened in the post COVID-19 era.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis was a hospital-based cross-sectional study conducted in 2017 in the largest tertiary health facility in northern Nigeria. Epidemiologic risk factors of interest were investigated using an interviewer administered questionnaire, followed by collection of a rectal swab sample. Regression analyses were conducted to appreciate what were the strengths of association between the outcome of interest as rectal carriage of CRE and the investigated risk factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRectal carriage of CRE was 4.2% (N=168) in this study. Age was independent protective risk factor (adjusted OR=0.2, CI:0.04 - 0.98, p=0.047) for the rectal carriage of CRE. Education appeared protective (OR=0.21, CI:0.06 - 0.76, p=0.018) while length of admission stay in Nigeria was not protective (adjusted OR=3.9, CI: 1.12 - 13.49, p=0.030) against rectal carriage of CRE. Also the ward a patient was admitted into was an important non-protective risk factor (aOR= 3.1, CI:1.14 - 8.20, p=0.030) for rectal carriage of CRE.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEpidemiologic risk factors for rectal carriage of CRE are quite similar within the LMIC context. It will be important to appreciate how these risk factors have changed since the COVID-19 pandemic. This would help make policies that focus on the most efficient counter measures to reduce the burden antimicrobial resistance in the LMIC.\u003c/p\u003e","manuscriptTitle":"Risk factors associated with rectal carriage of carbapenem resistant Enterobactorales in northern Nigeria: A hospital surveillance","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-08-14 16:09:01","doi":"10.21203/rs.3.rs-7223251/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-08T08:30:42+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-07T22:49:25+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-09-06T11:03:46+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"65320472226573990713403279963045320240","date":"2025-09-03T14:40:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-08-23T20:40:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"80237653831213623960653938060910818972","date":"2025-08-12T14:51:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"192020499755304675003595809788127923211","date":"2025-08-12T08:55:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"132157556381278098161924614070805567350","date":"2025-08-11T13:54:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"253727325181390814037034444578497602051","date":"2025-08-10T18:50:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"59643907732877799070607673674450590104","date":"2025-08-10T10:35:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-08-10T10:20:49+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-08-10T10:17:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-05T06:00:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-04T19:47:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Infectious Diseases","date":"2025-08-04T19:44:16+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-infectious-diseases","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"infd","sideBox":"Learn more about [BMC Infectious Diseases](http://bmcinfectdis.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/infd","title":"BMC Infectious Diseases","twitterHandle":"#bmcinfectdis","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"681d1289-4231-4246-b42f-74e651a641cd","owner":[],"postedDate":"August 14th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-11-03T16:00:06+00:00","versionOfRecord":{"articleIdentity":"rs-7223251","link":"https://doi.org/10.1186/s12879-025-11944-w","journal":{"identity":"bmc-infectious-diseases","isVorOnly":false,"title":"BMC Infectious Diseases"},"publishedOn":"2025-10-31 15:56:56","publishedOnDateReadable":"October 31st, 2025"},"versionCreatedAt":"2025-08-14 16:09:01","video":"","vorDoi":"10.1186/s12879-025-11944-w","vorDoiUrl":"https://doi.org/10.1186/s12879-025-11944-w","workflowStages":[]},"version":"v1","identity":"rs-7223251","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7223251","identity":"rs-7223251","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}