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From 2018 to 2020, we carried out a cross-sectional study in Germany, the Netherlands, and Romania among WWTP workers (N\u2009=\u2009344), nearby residents (living\u2009\u2264\u2009300\u00a0m away from WWTPs; N\u2009=\u2009431) and distant residents (living\u2009\u2265\u20091000\u00a0m away\u2009=\u2009reference group; N\u2009=\u20091165). We collected information on potential confounders via questionnaire. Culture of participants\u2019 stool samples was performed with ChromID\u00ae-ESBL agar plates and species identification with MALDI-TOF\u2013MS. We used logistic regression to estimate the odds ratio (OR) for carrying ESBL-producing\n                    <jats:italic>E. coli<\/jats:italic>\n                    (ESBL-EC). Sensitivity analyses included stratification by country and interaction models using country as secondary exposure. Prevalence of ESBL-EC was 11% (workers), 29% (nearby residents), and 7% (distant residents), and higher in Romania (28%) than in Germany (7%) and the Netherlands (6%). Models stratified by country showed that within the Romanian population, WWTP workers are about twice as likely (aOR\u2009=\u20092.34, 95% CI: 1.22\u20134.50) and nearby residents about three times as likely (aOR\u2009=\u20093.17, 95% CI: 1.80\u20135.59) to be ESBL-EC carriers, when compared with distant residents. In stratified analyses by country, we found an increased risk for carriage of ESBL-EC in Romanian workers and nearby residents. This effect was higher for nearby residents than for workers, which suggests that, for nearby residents, factors other than the local WWTP could contribute to the increased carriage.\n                  <\/jats:p>","DOI":"10.1007\/s10096-021-04387-z","type":"journal-article","created":{"date-parts":[[2021,12,13]],"date-time":"2021-12-13T10:03:50Z","timestamp":1639389830000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Carriage of ESBL-producing Enterobacterales in wastewater treatment plant workers and surrounding residents \u2014 the AWARE Study"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5355-0474","authenticated-orcid":false,"given":"Daloha","family":"Rodr\u00edguez-Molina","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8528-8095","authenticated-orcid":false,"given":"Fanny","family":"Berglund","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2965-4396","authenticated-orcid":false,"given":"Hetty","family":"Blaak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carl-Fredrik","family":"Flach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Merel","family":"Kemper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4045-079X","authenticated-orcid":false,"given":"Luminita","family":"Marutescu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6384-1822","authenticated-orcid":false,"given":"Gratiela Pircalabioru","family":"Gradisteanu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9939-1317","authenticated-orcid":false,"given":"Marcela","family":"Popa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beate","family":"Spie\u00dfberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Weinmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4730-1612","authenticated-orcid":false,"given":"Laura","family":"Wengenroth","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6098-1857","authenticated-orcid":false,"given":"Mariana Carmen","family":"Chifiriuc","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5496-0328","authenticated-orcid":false,"given":"D. 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In the Netherlands, this research is exempted for ethical approval under the Dutch Medical Research Involving Human Subjects Act (WMO; Committee: Medisch Ethische Toetsingscommissie, number of confirmation: 19\u2013001\/C). All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committees and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards, as well as with Directive 95\/46\/EC, and the 1977 Oviedo Convention of the Council of Europe on human rights and biomedicine. Written informed consent was obtained from all individual participants included in the study and their legal guardians when applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}