Objective To systematically evaluate the incidence of healthcare-associated infection (HAI) in adult cases with carbapenem-resistant Enterobacterales (CRE) colonization in intestine, and provide referential basis for the prevention and control of HAI in cases colonized with CRE intestinally. Methods Literatures on the incidence of HAI in cases with intestinal CRE colonization were retrieved from 8 databases, including Embase, Cochrane, PubMed, Web of Science, CNKI, Wanfang, VIP, and China Biomedical Literature Database (CBM), dating back from the establishment of the databases to June 2023. Meta-analysis was conducted by Stata 17.0 software. Stability of the research results was evaluated by sensitivity analysis, and publication bias was evaluated by Egger's test. Results A total of 16 articles were included in the study, with in total 2 151 cases from 5 Chinese articles and 11 English articles. Meta-analysis results showed that the incidence of HAI in adult cases with intestinal CRE colonization was 23.1% (95%CI: 14.8%-32.5%). Subgroup analysis was conducted based on grouping factors, such as different research design types, publication years, as well as research regions, departments, and infection sites. The differences in the combined effects among subgroups were not statistically significant (all P>0.05). Among the CRE developed from colonization to HAI, the proportion of carpabenem-resistant Klebsiella pneumoniae (CRKP) was 96.0% (95%CI: 86.8%-100%), and the incidence of bloodstream infection in colonized cases was 18.2% (95%CI: 10.3%-27.6%). The 30-day mortality of CRE colonized cases was 32.6% (95%CI: 20.5%-45.9%), and the 30-day mortality of CRE infected cases was 36.9% (95%CI: 16.0%-60.2%). Conclusion In recent years, the incidence of HAI in cases with CRE colonization is high, it is necessary to actively screen and focus on intervention in high-risk departments, so as to decrease the incidence of HAI in CRE colonized cases.