{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T18:27:59Z","timestamp":1786472879569,"version":"build-2736575974"},"reference-count":28,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T00:00:00Z","timestamp":1786406400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000030","name":"the Centers for Disease Control and Prevention","doi-asserted-by":"crossref","award":["U01CK000590"],"award-info":[{"award-number":["U01CK000590"]}],"id":[{"id":"10.13039\/100000030","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/100000002","name":"the National Institutes of Health","doi-asserted-by":"crossref","award":["1R01AI178121"],"award-info":[{"award-number":["1R01AI178121"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"crossref"}]},{"name":"the Texas Health Resources Clinical Scholars Program","award":["Clinical Scholars Program"],"award-info":[{"award-number":["Clinical Scholars Program"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"\n Background<\/jats:title>\n Carbapenem-resistant Enterobacterales (CRE) present a threat to global public health systems, yet the environmental contribution to antibiotic resistance prevalence has been understudied. The risk of antibiotic-resistant bacterium proliferating may be greater in neighborhoods experiencing environmental injustice (e.g., contaminated water, housing density). We examine spatial correlations between CRE detection rates and the Environmental Justice Index (EJI) across census tracts in an urban county.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We analyzed data from electronic health records of two major health systems from 2015\u20132020. Using global spatial autocorrelation tests (i.e., Global Moran\u2019s Index) and bivariate spatial lag regression models we analyzed the association of EJI components and local CRE rates.<\/jats:p>\n <\/jats:sec>\n \n Findings<\/jats:title>\n The overall EJI exhibited significant clustering in the study area (Moran\u2019s I\u2009=\u20090.51) and a strong positive association with local CRE positive culture rates (\u03b2\u2009=\u20090.44, SE\u2009=\u20090.10). The health vulnerability domain of the EJI (e.g., chronic disease burden) demonstrated the strongest association with CRE rates (\u03b2\u2009=\u20090.75, SE\u2009=\u20090.13). Measures of built environment (\u03b2\u2009=\u20090.42, SE\u2009=\u20090.16), water pollution (\u03b2\u2009=\u20090.41, SE\u2009=\u20090.11), housing type (\u03b2\u2009=\u20090.34, SE\u2009=\u20090.13) and housing characteristics (\u03b2\u2009=\u20090.41, SE\u2009=\u20090.10) displayed significantly strong associations with local CRE positive culture rates.<\/jats:p>\n <\/jats:sec>\n \n Interpretation<\/jats:title>\n These findings highlight the complex interplay between environmental conditions, social determinants, and health outcomes, indicating that areas with poor environmental quality and higher social vulnerability exhibited elevated CRE positive rates. This emphasizes the potential relevance of environmental and social disparities to antibiotic-resistant organism burden such as CRE.<\/jats:p>\n <\/jats:sec>","DOI":"10.1371\/journal.pone.0352253","type":"journal-article","created":{"date-parts":[[2026,8,11]],"date-time":"2026-08-11T17:28:45Z","timestamp":1786469325000},"page":"e0352253","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["A descriptive study of the association of Carbapenem-resistant Enterobacterales with environmental justice of a Southern urban county, USA"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5844-9084","authenticated-orcid":true,"given":"Alaina M.","family":"Beauchamp","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanvi A.","family":"Ingle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4000-9192","authenticated-orcid":true,"given":"Lauren N.","family":"Cooper","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John J.","family":"Hanna","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlon I.","family":"Diaz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard J.","family":"Medford","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,11]]},"reference":[{"key":"pone.0352253.ref001","doi-asserted-by":"crossref","DOI":"10.1093\/infdis\/jiw282","article-title":"The epidemiology of carbapenem-resistant enterobacteriaceae: the impact and evolution of a global menace","volume":"215","author":"LK Logan","year":"2017","journal-title":"J Infect Dis"},{"issue":"4","key":"pone.0352253.ref002","doi-asserted-by":"crossref","first-page":"730","DOI":"10.3390\/microorganisms9040730","article-title":"Present and future perspectives on therapeutic options for carbapenemase-producing enterobacterales infections","volume":"9","author":"CO Vrancianu","year":"2021","journal-title":"Microorganisms"},{"issue":"4","key":"pone.0352253.ref003","doi-asserted-by":"crossref","first-page":"2706","DOI":"10.1111\/1541-4337.13159","article-title":"Dissemination of carbapenemase-producing Enterobacteriaceae and associated resistance determinants through global food systems","volume":"22","author":"R Harding-Crooks","year":"2023","journal-title":"Compr Rev Food Sci Food Saf"},{"key":"pone.0352253.ref004","doi-asserted-by":"crossref","DOI":"10.1017\/ash.2023.235","article-title":"Detection of carbapenem-resistant Enterobacterales from nursing home wastewater effluent from September 2021 to November 2021","volume":"3","author":"S Lenz","year":"2023","journal-title":"ASHE"},{"issue":"2","key":"pone.0352253.ref005","article-title":"Frequency and diversity of carbapenemase-producing Enterobacterales recovered from untreated wastewater impacted by selective media containing cefotaxime and meropenem in Ohio, USA","volume":"18","author":"RJ Too","year":"2023","journal-title":"PLoS One"},{"key":"pone.0352253.ref006","doi-asserted-by":"crossref","DOI":"10.1096\/fasebj.2022.36.S1.0R432","article-title":"Providencia alcalifaciens is a highly antimicrobial resistant bacteria found in a Suburban Creek","volume":"36","author":"CD Carlson","year":"2022","journal-title":"FASEB J"},{"issue":"6","key":"pone.0352253.ref007","doi-asserted-by":"crossref","first-page":"533","DOI":"10.3122\/jabfm.2007.06.070019","article-title":"The role of poverty in antimicrobial resistance","volume":"20","author":"MB Planta","year":"2007","journal-title":"J Am Board Fam Med"},{"issue":"9","key":"pone.0352253.ref008","doi-asserted-by":"crossref","DOI":"10.1016\/S2542-5196(18)30186-4","article-title":"Anthropological and socioeconomic factors contributing to global antimicrobial resistance: a univariate and multivariable analysis","volume":"2","author":"P Collignon","year":"2018","journal-title":"Lancet Planet Health"},{"issue":"4","key":"pone.0352253.ref009","doi-asserted-by":"crossref","DOI":"10.1128\/jcm.00451-25","article-title":"The shift from \u201cMIC-Only\u201d back to carbapenemase testing among carbapenem-resistant Enterobacterales: what clinical laboratories need to know about updated CLSI guidance","volume":"64","author":"PJ Simner","year":"2026","journal-title":"J Clin Microbiol"},{"key":"pone.0352253.ref010","article-title":"Socioeconomic disparities and the prevalence of antimicrobial resistance","author":"LN Cooper","year":"2024","journal-title":"Clin Infect Dis"},{"key":"pone.0352253.ref011","unstructured":"Anselin L, Syabri I, Smirnov O. 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