NIHR Health Protection Research Unit in Healthcare-Associated Infections and Antimicrobial Resistance, Imperial College London, W12 0NN, London, UK.
Department of Healthcare-Associated Infections and Antimicrobial Resistance, National Infection Service, Public Health England, London, NW9 5EQ, UK.
Syst Rev. 2017 Dec 11;6(1):251. doi: 10.1186/s13643-017-0654-9.
Antibiotic resistance (ABR) is an urgent problem globally, with overuse and misuse of antibiotics being one of the main drivers of antibiotic-resistant infections. There is increasing evidence that the burden of community-acquired infections such as urinary tract infections and bloodstream infections (both susceptible and resistant) may differ by ethnicity, although the reasons behind this relationship are not well defined. It has been demonstrated that socioeconomic status and ethnicity are often highly correlated with each other; however, it is not yet known whether accounting for deprivation completely explains any discrepancy seen in infection risk. There have currently been no systematic reviews summarising the evidence for the relationship between ethnicity and antibiotic resistance or prescribing.
This protocol will outline how we will conduct this systematic literature review and meta-analysis investigating whether there is an association between patient ethnicity and (1) risk of antibiotic-resistant infections or (2) levels of antibiotic prescribing in high-income countries. We will search PubMed/MEDLINE, EMBASE, Global Health, Scopus and CINAHL using MESH terms where applicable. Two reviewers will conduct title/abstract screening, data extraction and quality assessment independently. The Critical Appraisal Skills Programme (CASP) checklist will be used for cohort and case-control studies, and the Cochrane collaboration's risk of bias tool will be used for randomised control trials, if they are included. Meta-analyses will be performed by calculating the minority ethnic group to majority ethnic group odds ratios or risk ratios for each study and presenting an overall pooled odds ratio for the two outcomes. The Grading of Recommendations, Assessments, Development and Evaluation (GRADE) approach will be used to assess the overall quality of the body of evidence.
In this systematic review and meta-analysis, we will aim to collate the available evidence of whether there is a difference in rates of AMR and/or antibiotic prescribing in minority vs. majority ethnic groups in high-income countries. Additionally, this review will highlight areas where more research needs to be conducted and may provide insight into what may cause differences in this relationship, should they be seen.
PROSPERO ( CRD42016051533 ).
抗生素耐药性（ABR）是一个全球性的紧急问题，抗生素的过度和滥用是导致抗生素耐药性感染的主要驱动因素之一。越来越多的证据表明，尿路感染和血流感染等社区获得性感染的负担（包括敏感和耐药感染）可能因种族而异，尽管这种关系背后的原因尚未明确。已经证明，社会经济地位和种族通常高度相关；然而，目前尚不清楚是否考虑到贫困程度可以完全解释感染风险方面的任何差异。目前还没有系统评价总结种族与抗生素耐药性或处方之间关系的证据。
本方案将概述我们如何进行这项系统文献综述和荟萃分析，以调查患者种族与（1）抗生素耐药感染的风险或（2）高收入国家抗生素处方水平之间是否存在关联。我们将使用适用于主题词的 PubMed/MEDLINE、EMBASE、全球健康、Scopus 和 CINAHL 进行搜索。两名审查员将独立进行标题/摘要筛选、数据提取和质量评估。Cochrane 协作风险偏倚工具将用于随机对照试验，如果纳入的话，也将用于队列和病例对照研究的关键评估技能计划（CASP）清单。将通过计算每个研究的少数民族群体与多数族裔群体的优势比或风险比来进行荟萃分析，并为两个结果呈现一个总体汇总优势比。将使用推荐评估、制定和评价分级（GRADE）方法来评估证据总体质量。
在这项系统评价和荟萃分析中，我们将旨在收集关于在高收入国家中，少数民族与多数族裔群体之间抗生素耐药率和/或抗生素处方是否存在差异的现有证据。此外，这项综述将突出需要进一步研究的领域，并可能深入了解如果存在这种关系，可能导致这种关系差异的原因。
PROSPERO（CRD42016051533）。
