Bezabih Yihienew M, Bezabih Alemayehu, Dion Michel, Batard Eric, Teka Samson, Obole Abiy, Dessalegn Noah, Enyew Alelegn, Roujeinikova Anna, Alamneh Endalkachew, Mirkazemi Corinne, Peterson Gregory M, Bezabhe Woldesellassie M
Arsi University College of Health Sciences, University Road, Asella, ET 0193, Ethiopia.
Bahir Dar University, Bahir Dar, Ethiopia.
JAC Antimicrob Resist. 2022 Jun 2;4(3):dlac048. doi: 10.1093/jacamr/dlac048. eCollection 2022 Jun.
The widespread intestinal carriage of ESBL-producing (ESBL ) 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.
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.
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 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.
The global and regional human intestinal ESBL 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 in both settings.
产超广谱β-内酰胺酶（ESBL）细菌在患者和健康个体中广泛存在于肠道，这令人担忧。然而，这种多重耐药菌在医疗机构中的全球流行率和趋势仍未确定。为填补这一知识空白，我们对社区和医疗机构中的流行率进行了比较性荟萃分析。
我们的系统评价纳入了2000年1月1日至2021年4月22日期间发表并被PubMed、EMBASE或谷歌学术索引的133篇文章。进行随机效应荟萃分析以获得全球合并流行率（社区和医疗机构）。通过按世界卫生组织区域和研究期间的5年间隔对研究进行分组来进行亚组荟萃分析。
我们发现，全球范围内，医疗机构中的住院患者有21.1%（95%CI，19.1%-23.2%）肠道携带ESBL，健康个体中有17.6%（95%CI，15.3%-19.8%）肠道携带ESBL。医疗机构中的全球携带率从2001 - 2005年的7%（95%CI，3.7%-10.3%）增加了3倍，至2016 - 2020年的25.7%（95%CI，19.5%-32.0%），而在社区环境中，同期从2.6%（95%CI，1.2%-4.0%）增加了10倍，至26.4%（95%CI，17.0%-35.9%）。
社区和医疗机构中全球及区域人类肠道ESBL携带率均在上升。医疗机构中的携带率通常高于社区环境。关键相关卫生组织应开展监测并实施预防措施，以应对ESBL在这两种环境中的传播。
