The global prevalence and trend of human intestinal carriage of ESBL-producing <em>Escherichia coli</em> in the community

<p>Objectives: Intestinal colonization by ESBL <em>Escherichia coli</em> and its association with community-acquired MDR infections is of great concern. This review determined the worldwide prevalence of human faecal ESBL <em>E. coli</em> carriage and its trend in the community over the past two decades.</p> <p>Methods: A systematic literature search was conducted using PubMed, EMBASE and Google Scholar to retrieve articles published between 1 January 2000 and 13 February 2020 that contained data on the prevalence of faecal carriage of ESBL <em>E. coli</em> among healthy individuals. A cumulative (for the whole period) meta-analysis was used to estimate the global and regional pooled prevalence rates. Articles were grouped into study periods of 3 years, and subgroup meta-analyses were undertaken to examine the global pooled prevalence over time.</p> <p>Results: Sixty-two articles covering 29 872 healthy persons were included in this meta-analysis. The cumulative (2003–18) global pooled prevalence of ESBL <em>E. coli</em> intestinal carriage in the community was 16.5% (95% CI 14.3%–18.7%; <em>P</em> < 0.001). The pooled prevalence showed an upward trend, increasing from 2.6% (95% CI 1.6%–4.0%) in 2003–05 to 21.1% (95% CI 15.8%–27.0%) in 2015–18. Over the whole period, the highest carriage rate was observed in South-East Asia (27%; 95% CI 2.9%–51.3%), while the lowest occurred in Europe (6.0%; 95% CI 4.6%–7.5%).</p> <p>Conclusions: Globally, an 8-fold increase in the intestinal carriage rate of ESBL <em>E. coli</em> in the community has occurred over the past two decades. Prevention of its spread may require new therapeutic and public health strategies.</p>