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Meta-Analysis
. 2020 Feb 11;9(1):31.
doi: 10.1186/s13756-020-0691-3.

Risk factors for fecal carriage of drug-resistant Escherichia coli: a systematic review and meta-analysis

Yuan Hu  1 , Yusuke Matsui  2 , Lee W Riley  2
Affiliations
Meta-Analysis

Risk factors for fecal carriage of drug-resistant Escherichia coli: a systematic review and meta-analysis

Yuan Hu et al. Antimicrob Resist Infect Control. .

Abstract

Background: Antimicrobial resistance is a serious public health problem. Fecal carriage of drug-resistant bacteria has been suggested as an important source of antimicrobial resistant genes (ARGs). We aimed to identify risk factors associated with fecal carriage of drug-resistant commensal Escherichia coli among healthy adult population.

Methods: We conducted a systematic review and meta-analysis following the PRISMA guideline. We identified observational studies published from 2014 to 2019 through PubMed, Embase, and Web of Science. Studies were eligible if they investigated and reported risk factors and accompanying measure of associations for fecal carriage of drug-resistant E. coli for healthy population aged 18-65. Data on risk factors assessed in three or more studies were extracted.

Results: Fifteen of 395 studies involving 11480 healthy individuals were included. The pooled prevalence of drug-resistant Enterobacteriaceae was 14% (95% confidence interval [CI] 8-23%). Antimicrobial use within the 12 months prior to stool culture (odds ratio [OR] 1.84 [95%CI 1.35-2.51]), diarrhea symptoms (OR 1.56 [95%CI 1.09-2.25]), travel to India (OR 4.15 [95%CI 2.54-6.78]), and vegetarian diet (OR 1.60 [95%CI 1.00(1.0043)-2.56(2.5587)]) were associated with increased risk of fecal carriage of drug-resistant E. coli. Among travellers, antimicrobial use (OR 2.81 [95%CI 1.47-5.36]), diarrhea symptoms (OR 1.65 [95%CI 1.02-2.68]), travel to India (OR 3.80 [95%CI 2.23-6.47]), and vegetarian diet (OR 1.92 [95%CI 1.13-3.26]) were associated with increased risk. Among general adult population, antimicrobial use (OR 1.51 [95%CI 1.17-1.94]), diarrhea symptoms (OR 1.53 [95%CI 1.27-1.84]), and travel to Southeast Asia (OR 1.67 [95%CI 1.02-2.73]) were associated with the increased risk of drug-resistant E. coli carriage.

Conclusions: The findings indicate that dietary habit as well as past antimicrobial use and travel to high-risk country are associated with the risk of fecal carriage of drug-resistant commensal E. coli.

Keywords: Commensal Escherichia coli; Drug resistance; Meta-analysis; Risk factors; Systematic review.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA Flow Diagram. Flow diagram of the systematic review process used to identify eligible studies
Fig. 2
Fig. 2
Forest plots for individuals and combined prevalence estimates of fecal carriage of drug-resistant bacteria. a Prevalence of drug-resistant Enterobacteriaceae and prevalence of ESBL-producing Enterobacteriaceae; b Prevalence of drug-resistant Enterobacteriaceae among travellers and general populations
Fig. 3
Fig. 3
Forest plots for significant risk factors. a Individuals and combined OR of fecal carriage of drug-resistant E. coli among entire population; b Individuals and combined OR of fecal carriage of drug-resistant E. coli among travellers; c Individuals and combined OR of fecal carriage of drug-resistant E. coli among general population. OR, odds ratio
Fig. 4
Fig. 4
Funnel plots. Funnel plots for studies reporting antimicrobial use, diarrhea, vegetarian diet, and travel to India as risk factors
See this image and copyright information in PMC

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