A systematic review and meta-analysis of the economic burden of carbapenem-resistant Enterobacterales (CRE) infection

Carbapenem-resistant Enterobacterales (CRE) are a globally prioritized group of multidrug-resistant bacteria, imposing a substantial clinical and economic burden worldwide.

To synthesize recent evidence on the economic burden of CRE infection, focusing on hospitalization costs, length of stay (LOS), and mortality.

Medline, Embase and Web of Science were searched for relevant studies published from 2019 to 2025. Study selection, data extraction and risk of bias assessment were conducted sequentially, followed by narrative synthesis for hospitalization costs and meta-analysis for LOS and mortality, with subgroup analyses according to comparator type.

21 studies were included. CRE infection was associated with increased hospitalization costs compared with control groups. Compared with carbapenem-susceptible Enterobacterales infection, CRE infection was associated with prolonged LOS (MD = 14.16, 95% CI: 11.43-16.88) and was associated with higher mortality (OR = 1.96, 95% CI: 1.63-2.36). Studies using uninfected controls reported a greater estimated burden associated with CRE infection. Sensitivity analyses supported the robustness of the pooled findings.

CRE infection is associated with increased hospitalization costs, prolonged LOS, and higher mortality, resulting in a substantial economic burden. Strengthening prevention and control measures is essential to reduce its adverse impact.