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Comparison of the global prevalence and trend of human intestinal carriage of ESBL-producing Escherichia coli between healthcare and community settings: a systematic review and meta-analysis


Bezabih, YM and Bezabih, A and Dion, M and Batard, E and Teka, S and Obole, A and Dessalegn, N and Enyew, A and Roujeinikova, A and Alamneh, E and Mirkazemi, C and Peterson, G and Bezabhe, WM, Comparison of the global prevalence and trend of human intestinal carriage of ESBL-producing Escherichia coli between healthcare and community settings: a systematic review and meta-analysis, JAC - Antimicrobial Resistance, 4, (3) Article dlac048. ISSN 2632-1823 (2022) [Refereed Article]

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Copyright Statement

2022. The Authors. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. This article is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) License (, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

DOI: doi:10.1093/jacamr/dlac048


Objectives: The widespread intestinal carriage of ESBL-producing Escherichia coli (ESBL E. coli) among both patients and healthy individuals is alarming. However, the global prevalence and trend of this MDR bacterium in healthcare settings remains undetermined. To address this knowledge gap, we performed a comparative meta-analysis of the prevalence in community and healthcare settings.

Methods: Our systematic review included 133 articles published between 1 January 2000 and 22 April 2021 and indexed in PubMed, EMBASE or Google Scholar. A random-effects meta-analysis was performed to obtain the global pooled prevalence (community and healthcare settings). Subgroup meta-analyses were performed by grouping studies using the WHO regions and 5 year intervals of the study period.

Results: We found that 21.1% (95% CI, 19.1%-23.2%) of inpatients in healthcare settings and 17.6% (95% CI, 15.3%-19.8%) of healthy individuals worldwide carried ESBL E. coli in their intestine. The global carriage rate in healthcare settings increased 3-fold from 7% (95% CI, 3.7%-10.3%) in 2001-05 to 25.7% (95% CI, 19.5%-32.0%) in 2016-20, whereas in community settings it increased 10-fold from 2.6% (95% CI, 1.2%-4.0%) to 26.4% (95% CI, 17.0%-35.9%) over the same period.

Conclusions: The global and regional human intestinal ESBL E. coli carriage is increasing in both community and healthcare settings. Carriage rates were generally higher in healthcare than in community settings. Key relevant health organizations should perform surveillance and implement preventive measures to address the spread of ESBL E. coli in both settings.

Item Details

Item Type:Refereed Article
Keywords:antibiotics; resistance; ESBL-producing Escherichia coli; epidemiology
Research Division:Biomedical and Clinical Sciences
Research Group:Clinical sciences
Research Field:Infectious diseases
Objective Division:Health
Objective Group:Clinical health
Objective Field:Efficacy of medications
UTAS Author:Alamneh, E (Dr Endalkachew Alamneh)
UTAS Author:Mirkazemi, C (Dr Corinne Mirkazemi)
UTAS Author:Peterson, G (Professor Gregory Peterson)
UTAS Author:Bezabhe, WM (Dr Woldesellassie Bezabhe)
ID Code:150429
Year Published:2022
Web of Science® Times Cited:4
Deposited By:Pharmacy
Deposited On:2022-06-14
Last Modified:2022-10-19
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