Chicken or egg? The role of dysbiosis in intestinal carriage of carbapenemase-producing Enterobacterales

BACKGROUND: Carbapenemase-producing Enterobacterales (CPE) have a well-established capability of spreading in healthcare environments and cause outbreaks in hospital wards. AIM: To determine whether intestinal dysbiosis is associated with intestinal carriage of CPE; also to investigate treatment with antibiotics, and hospitalization prior to study inclusion. METHODS: A systematic search of the PubMed, Embase, and Cochrane databases was conducted in September 2024, and studies were included where the authors compared microbiome analysis of CPE carriers with microbiome analysis of non-carriers. FINDINGS: The search resulted in 1812 records. After removing duplicates, and non-eligible records based on title and abstract screening, 67 records were retrieved for full-text screening. Of these, four studies were included in the systematic review including 140 CPE carriers and 141 controls. In three studies the authors found dysbiosis in the group of CPE carriers, and in the fourth study they found a decrease in diversity in CPE carriers compared with healthy adults; however, there was no decrease in diversity compared with hospitalized non-carriers. CONCLUSION: This systematic review has revealed an association between intestinal dysbiosis and intestinal carriage of CPE. Nonetheless, the potential influence of antibiotic treatment on this result cannot be dismissed.