Published in PLOS One on 2026-07-31, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Amanuale Zayede, Yitayih Wondimeneh, Sirak Biset, Mucheye Gizachew
Source: PLOS One • DOI 10.1371/journal.pone.0355041
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Extended-spectrum beta-lactamase (ESBL) and carbapenemase-producing Enterobacteriaceae (CPE) pose a critical public health threat. Janitors are routinely exposed to contaminated environments and may act as a reservoir for these resistant bacteria, particularly in resource-limited settings like Ethiopia, where data on this subject are scarce.
The aim of this study was to assess fecal carriage rates of ESBL-PE, CPE and its associated factors among hospital and non-hospital janitors at the University of Gondar (UoG), Northwest Ethiopia.
A comparative cross-sectional study was conducted from June 15 to September 25, 2025, at the UoG. A total of 385 janitors (203 hospital and 182 non-hospital) were selected using stratified and simple random sampling techniques. Data on socio-demographic and associated factors were collected using a semi-structured questionnaire. Stool samples were collected aseptically and cultured on MacConkey agar. Antimicrobial resistance (AMR) patterns were determined by the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute (CLSI) 2024 guidelines. The ESBL and carbapenemase production were confirmed using the combination disk and modified Carbapenem inactivation methods, respectively. Quality control was ensured by using standard reference strains. Data analysis was performed using SPSS version 27.0, employing chi-square tests and logistic regression. A p-value of <0.05 was considered statistically significant.
Among the 385 stool samples, a total of 416 Enterobacteriaceae isolates were recovered, 229 from hospital janitors and 187 from non-hospital janitors. The overall fecal carriage rates among janitors were 83 (21.6%) for ESBL-PE and 14 (3.6%) for CPE. Hospital janitors had significantly higher carriage rate than non-hospital janitors for both ESBL-PE (28.6% vs. 13.7%, p < 0.001) and CPE (5.9% vs. 1.1%, p = 0.012), respectively. Escherichia coli was the predominant ESBL-producer. Significant risk factors identified for ESBL-PE colonization included lack of hand hygiene at home, history of antibiotic use, and urinary tract infection for hospital janitors, and age ≥ 40 years and history of non-prescription antibiotic use were for non-hospital janitors.
This high carriage rates of ESBL-PE and CPE, identify janitors as a significant reservoir for resistant bacteria. We recommend integrating janitors into national AMR surveillance programs and strengthening infection prevention and control and antimicrobial stewardship training.
Introduction
Enterobacteriaceae are a large family of Gram-negative bacteria (GNB) that includes pathogens in the genus Escherichia, Klebsiella, Salmonella, Shigella, and Enterobacter. These bacteria can cause a wide range of infections in the skin and soft tissue, bloodstream, urinary, respiratory, cardiovascular, and central nervous systems, both in healthcare settings and the community [1,2]. Of particular concern are Carbapenem and third-generation cephalosporin-resistant Enterobacteriaceae, which the World Health Organization (WHO) has classified them as critical-priority pathogens due to their high resistance to last-resort antibiotics [3].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider hospital systems desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Amanuale Zayede, Yitayih Wondimeneh, Sirak Biset, Mucheye Gizachew. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Multidrug resistance and carbapenemase producing Enterobacteriaceae isolated from clinical samples, Addis Ababa, Ethiopia: A cross-sectional study
- Evidence brief: Contamination of Hospital Inanimate Surfaces with Methicillin-Resistant Staphylococcus aureus and Extended-Spectrum Beta-Lactamase producing bacteria at Ocean Road Cancer Institute, Dar es Salaam, Tanzania
- Evidence brief: Genomic epidemiology of multidrug-resistant and ESBL-producing Proteus mirabilis in a military referral hospital in Ethiopia
