Fecal carriage of multidrug-resistant Enterobacterales and its associated factors among hospital and non-hospital janitors at the University of Gondar, Northwest Ethiopia: a comparative cross-sectional study

Abstract

Multidrug-resistant (MDR) Enterobacterales represent a severe global health challenge. Janitors, who are frequently in contact with contaminated surfaces, may become carriers and spreaders of these pathogens. This risk is especially acute in resource-constrained environments such as Ethiopia, where research into this potential transmission route remains scarce. The aim of this study was to assess fecal carriage rates of multidrug-resistant Enterobacterales 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 a stratified and simple random sampling techniques. Data on socio-demographic and associated factor were collected using a semi-structured questionnaire. Stool samples were collected aseptically, cultured on MacConkey agar, and identified using biochemical test results. Antimicrobial resistance (AMR) patterns were determined by the Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute (CLSI) 2024 guidelines. Quality control was ensured by using standard reference strain (E. coli ATCC 25922). 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 Enterobacterales isolates were recovered, 229 from hospital janitors and 187 from non-hospital janitors. The overall fecal carriage rate of MDR Enterobacterales among janitors was 54.0% (95% CI 48.9, 59.1). This rate was significantly higher in hospital janitors compared to non-hospital janitors ((63.5% (95% CI 56.5, 70.2) vs. 43.4% (95% CI 36.1, 50.9), respectively; p < 0.001)). History of antibiotic use, urinary tract infection, and gastrointestinal tract symptom in the last three months were significantly associated with MDR Enterobacterales carriage among janitors. The high carriage rates of MDR Enterobacterales identified among janitors suggest that janitors may serve as a potential reservoir for resistant bacteria. To address this, we recommend their inclusion in national antimicrobial resistance surveillance programs and the implementation of tailored infection prevention and control training.