{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T19:23:21Z","timestamp":1773084201072,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.157380.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000}}],"reference-count":26,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T00:00:00Z","timestamp":1741564800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns7:p>Abstract Background Carbapenem-resistant Enterobacterales (CRE) pose a significant global health threat, with increasing prevalence worldwide, including in Indonesia. Despite the public health impact, comprehensive data on the burden of CRE in Indonesia remains fragmented. This protocol outlines a systematic review and meta-analysis aiming to estimate the prevalence of CRE in Indonesia, summarize trends over time, and identify key resistance mechanisms. Methods We will conduct a systematic search across multiple electronic databases, including PubMed, Scopus, and local Indonesian databases, for studies reporting the prevalence of CRE in Indonesia from 2004 to 2024. Eligibility criteria include observational studies (cross-sectional, cohort, and case-control) and surveillance reports. Data extraction will focus on CRE prevalence, bacterial species, sample types, resistance mechanisms, and study settings (hospital vs. community). Quality assessment of studies will be performed using the Newcastle-Ottawa Scale (NOS). Meta-analysis will be conducted using a random-effects model to estimate pooled prevalence, and subgroup analysis will explore variations by geographical region, period, and healthcare setting. Discussion This systematic review and meta-analysis will provide the first comprehensive overview of CRE prevalence in Indonesia, contributing to an improved understanding of the national burden and resistance patterns. The findings will guide public health policies and inform antimicrobial stewardship efforts in Indonesia. Registration PROSPERO CRD42024580177<\/ns7:p>","DOI":"10.12688\/f1000research.157380.2","type":"journal-article","created":{"date-parts":[[2025,3,10]],"date-time":"2025-03-10T12:20:07Z","timestamp":1741609207000},"page":"1244","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Carbapenem-resistant Enterobacterales (CRE) in Indonesia: protocol for systematic review and meta-analysis"],"prefix":"10.12688","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5949-252X","authenticated-orcid":false,"given":"Ika N.","family":"Kadariswantiningsih","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maulana A.","family":"Empitu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bulat","family":"Idrisov","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-5482-0613","authenticated-orcid":false,"given":"Derren David Christian Homenta","family":"Rampengan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Roy Novri","family":"Ramadhan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2025,3,10]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.1099\/jmm.0.001462","article-title":"JMM Profile: Carbapenems: a broad-spectrum antibiotic.","volume":"70","author":"T Armstrong","year":"2021","journal-title":"J. Med. Microbiol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"15-21","DOI":"10.1177\/2049936115621709","article-title":"Carbapenem resistance: overview of the problem and future perspectives.","volume":"3","author":"G Meletis","year":"2016","journal-title":"Ther. Adv. Infect. Dis."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"S28-S36","DOI":"10.1093\/infdis\/jiw282","article-title":"The Epidemiology of Carbapenem-Resistant Enterobacteriaceae: The Impact and Evolution of a Global Menace.","volume":"215","author":"L Logan","year":"2017","journal-title":"J. Infect. Dis."},{"key":"ref4","first-page":"460-469","article-title":"The Global Epidemiology of Carbapenemase-Producing Enterobacteriaceae.","volume":"8","author":"D Duin","year":"2016","journal-title":"Virulence."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1-22","DOI":"10.1128\/CMR.00042-16","article-title":"Carbapenem-Resistant Acinetobacter Baumannii and Enterobacteriaceae in South and Southeast Asia.","volume":"30","author":"L Hsu","year":"2017","journal-title":"Clin. Microbiol. Rev."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"30-46","DOI":"10.1016\/j.drup.2016.09.002","article-title":"The Rapid Spread of Carbapenem-Resistant Enterobacteriaceae.","volume":"29","author":"R Potter","year":"2016","journal-title":"Drug Resist. Updat."},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1128\/AAC.00698-21","article-title":"Assessment of Mortality-Related Risk Factors and Effective Antimicrobial Regimens for Treatment of Bloodstream Infections Caused by Carbapenem-Resistant Enterobacterales.","volume":"65","author":"L Chen","year":"2021 Aug 17","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"6345-6355","DOI":"10.2147\/IDR.S418066","article-title":"Fecal Carriage of Carbapenem Resistant Enterobacterales and Associated Factors Among Admitted Patients in Saint Paul\u2019s Hospital Millennium Medical College, Addis Ababa, Ethiopia.","volume":"16","author":"Y Mekonnen","year":"2023","journal-title":"Infect. Drug Resist."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"303-315","DOI":"10.1016\/j.cll.2017.01.005","article-title":"Carbapenem-Resistant Enterobacteriaceae.","volume":"37","author":"A Iovleva","year":"2017","journal-title":"Clin. Lab. Med."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"367-376","DOI":"10.1556\/030.66.2019.020","article-title":"Carbapenem Resistance in Escherichia Coli and Klebsiella Pneumoniae Among Indian and International Patients in North India.","volume":"66","author":"N Jaggi","year":"2019","journal-title":"Acta Microbiol. Immunol. Hung."},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1186\/s13756-021-00950-7","article-title":"Molecular Epidemiology of Carbapenem-Resistant Enterobacterales in Thailand, 2016\u20132018. Antimicrob Resist.","volume":"10","author":"W Paveenkittiporn","year":"2021","journal-title":"Infect. Control."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"43-47","DOI":"10.36348\/merjmb.2023.v03i02.004","article-title":"Detection of Carbapenem Resistance Among Enterobacteriaceae Pathogens Isolated From Clinical Samples in Shendi Locality.","volume":"3","author":"A Musa","year":"2023","journal-title":"Middle East Res. J. Microbiol. Biotechnol."},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.19045\/bspab.2020.90175","article-title":"Detection of Carbapenem Resistant Klebsiella Species Isolated From Clinical Samples.","volume":"9","author":"S Ali","year":"2020","journal-title":"Pure Appl. Biol."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"966-972","DOI":"10.1111\/iju.13787","article-title":"Occurrence and characterization of carbapenem-resistant Gram-negative bacilli: A collaborative study of antibiotic-resistant bacteria between Indonesia and Japan.","volume":"25","author":"K Kuntaman","year":"2018 Nov","journal-title":"Int. J. Urol."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"376-385","DOI":"10.3978\/j.issn.2072-1439.2014.12.33","article-title":"Epidemiology of carbapenem resistant Enterobacteriaceae (CRE) during 2000-2012 in Asia.","volume":"7","author":"Y Xu","year":"2015 Mar","journal-title":"J. Thorac. Dis."},{"key":"ref16","doi-asserted-by":"crossref","first-page":"1-3","DOI":"10.1186\/s13643-021-01671-z","article-title":"How to properly use the PRISMA Statement.","volume":"10","author":"R Sarkis-Onofre","year":"2021","journal-title":"Syst. Rev."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"80-84","DOI":"10.13105\/wjma.v5.i4.80","article-title":"Assessing the quality of studies in meta-analyses: Advantages and limitations of the Newcastle Ottawa Scale.","volume":"5","author":"C Luchini","year":"2017 Aug 26","journal-title":"World J. Meta-Anal."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"537-553","DOI":"10.1002\/jrsm.1260","article-title":"Introduction, comparison, and validation of Meta-Essentials: A free and simple tool for meta-analysis.","volume":"8","author":"R Suurmond","year":"2017 Dec","journal-title":"Res. Synth. Methods."},{"key":"ref19","doi-asserted-by":"publisher","DOI":"10.1111\/tmi.14090","article-title":"Antibiotic resistance in Indonesia: A systematic review and meta-analysis of extended-spectrum beta-lactamase-producing bacteria (2008-2024).","author":"I Kadariswantiningsih","year":"2025 Jan 31","journal-title":"Trop. Med. Int. Health."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"1-22","DOI":"10.1128\/CMR.masthead.30-1","article-title":"Carbapenem-Resistant Acinetobacter baumannii and Enterobacteriaceae in South and Southeast Asia.","volume":"30","author":"L Hsu","year":"2017 Jan","journal-title":"Clin. Microbiol. Rev."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"2377-2379","DOI":"10.1056\/NEJMp1011715","article-title":"NDM-1--a cause for worldwide concern.","volume":"363","author":"R Moellering","year":"2010 Dec 16","journal-title":"N. Engl. J. Med."},{"key":"ref22","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1186\/s13756-020-00716-7","article-title":"Clinical impact of endemic NDM-producing Klebsiella pneumoniae in intensive care units of the national referral hospital in Jakarta, Indonesia.","volume":"9","author":"Y Saharman","year":"2020 May 11","journal-title":"Antimicrob. Resist. Infect. Control."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"1034-1037","DOI":"10.3201\/eid2106.141504","article-title":"KPC and NDM-1 genes in related Enterobacteriaceae strains and plasmids from Pakistan and the United States.","volume":"21","author":"M Pesesky","year":"2015 Jun","journal-title":"Emerg. Infect. Dis."},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2929-2933","DOI":"10.1128\/AAC.02047-13","article-title":"Spread of NDM-1-producing Enterobacteriaceae in a neonatal intensive care unit in Istanbul, Turkey.","volume":"58","author":"L Poirel","year":"2014 May","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"141-147","DOI":"10.1016\/j.jgar.2014.02.007","article-title":"High burden of antimicrobial drug resistance in Asia.","volume":"2","author":"C Lai","year":"2014 Sep","journal-title":"J. Glob. Antimicrob. Resist."},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.6084\/m9.figshare.27134661.v6","author":"I Kadariswantiningsih","year":"2024","journal-title":"figshare."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/13-1244\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/13-1244\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/13-1244\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,3]],"date-time":"2026-03-03T00:54:09Z","timestamp":1772499249000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/13-1244\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,10]]},"references-count":26,"URL":"https:\/\/doi.org\/10.12688\/f1000research.157380.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.157380.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.178768.r370284","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.178768.r370283","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.178768.r370284","asserted-by":"object"},{"id-type":"doi","id":"10.5256\/f1000research.178768.r370283","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,10]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/13-1244\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.178768.r370283, Oznur Caliskan-Aydogan, Michigan State University, East Lansing, Michigan, 08 Apr 2025, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/13-1244\/v2#referee-response-370283","order":0,"name":"referee-response-370283","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.178768.r370284, Harvey Morgan Scott, Ingrid Maribel Leon Moreno, Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A&M University, College Station, TX, 21 Mar 2025, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/13-1244\/v2#referee-response-370284","order":1,"name":"referee-response-370284","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":2,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}