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

Yihienew M. Bezabih, Wilber Sabiiti, Endalkachew Aalamneh, Alemayehu Bezabih, Gregory Peterson, Woldesellassie M. Bezabhe, Anna Roujeinikova

Research output: Contribution to journalReview articlepeer-review

4 Citations (Scopus)
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Objectives: Intestinal colonization by ESBL Escherichia coli and its association with community-acquired MDR infections is of great concern. This review determined the worldwide prevalence of human faecal ESBL E. coli carriage and its trend in the community over the past two decades.

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 E. coli 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.

Results: Sixty-two articles covering 29 872 healthy persons were included in this meta-analysis. The cumulative (2003–18) global pooled prevalence of ESBL E. coli intestinal carriage in the community was 16.5% (95% CI 14.3%–18.7%; P  <  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%).

Conclusions: Globally, an 8-fold increase in the intestinal carriage rate of ESBL E. coli in the community has occurred over the past two decades. Prevention of its spread may require new therapeutic and public health strategies.
Original languageEnglish
Article numberdkaa399
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
VolumeAdvance Article
Early online date9 Oct 2020
Publication statusE-pub ahead of print - 9 Oct 2020


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