Fecal Colonization With Extended spectrum Beta lactamase Producing Enterobacteriaceae and Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis.
BACKGROUND Gut colonization is a risk factor for infections with extended spectrum beta lactamase (ESBL) producing organisms. We aimed to determine the ESBL class A reservoir among healthy individuals. METHODS We searched PubMed and EMBASE (through 10 July 2015) looking for studies that contained data for fecal colonization with ESBL class A bacteria among healthy individuals for each World Health Organization defined region. Distribution of isolates among cefotaximase (CTX M) sulfhydryl variable, and temoneira enzymes and data on previous antibiotic use, international travel, previous hospitalization, and animal contacts were extracted. RESULTS Sixty six of 17 479 studies on 28 909 healthy individuals were included. The pooled prevalence of ESBL class A colonization was 14% (95% confidence interval [CI] 9, 20) with an increasing trend of 5.38% annually (P .003) The pooled prevalence was higher in Asia and Africa (ranging from 46% 95% CI, 29, 63 to 15% 95% CI, 4, 31) and lower but still significant in central (3% 95% CI, 1, 5) northern (4% 95% CI, 2, 6) and southern Europe (6% 95% CI, 1, 12) and the Americas (2% 95% CI, 0, 5) CTX Ms were the prevalent ESBL enzyme (69% Antibiotic use for the prior 4 or 12 months was associated with a high colonization risk (risk ratio [RR] 1.63; 95% CI, 1.19, 2.24 and RR 1.58; 95% CI, 1.16, 2.16, respectively) International travel was also correlated with ESBL colonization (RR 4.06, (95% CI, 1.33, 12.41) CONCLUSIONS The ESBL colonization rate among healthy individuals is significant worldwide. This should be taken into consideration in infection control and antibiotic management decisions.
Clinical infectious diseases an official publication of the Infectious Diseases Society of America