Gut mucosal colonisation with extended-spectrum beta-lactamase producing Enterobacteriaceae in sub-Saharan Africa: a systematic review and meta-analysis

Lewis, Joseph ORCID: https://orcid.org/0000-0002-3837-5188, Lester, Rebecca ORCID: https://orcid.org/0000-0002-0259-9630, Garner, Paul ORCID: https://orcid.org/0000-0002-0607-6941 and Feasey, Nicholas ORCID: https://orcid.org/0000-0003-4041-1405 (2019) 'Gut mucosal colonisation with extended-spectrum beta-lactamase producing Enterobacteriaceae in sub-Saharan Africa: a systematic review and meta-analysis'. Wellcome Open Research, Vol 4, Issue 160.

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Abstract

Background: Extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E) threaten human health; and, in areas of sub-Saharan Africa (sSA) where carbapenems are not available, may render ESBL-E infections untreatable. Gut mucosal colonisation probably occurs before infection, making prevention of colonisation an attractive target for intervention, but the epidemiology of ESBL-E in sSA is poorly described.

Objectives: Describe ESBL-E colonisation prevalence in sSA and risk factors associated with colonisation.
Methods: Studies included were prospective cross-sectional or cohort studies reporting gut mucosal ESBL-E colonisation in any population in sSA. We searched PubMed and Scopus on 18 December 2018. We summarise the range of prevalence across sites and tabulated risk factors for colonisation. The protocol was registered (Prospero ID CRD42019123559).

Results: From 2975 abstracts we identified 32 studies including a total of 8619 participants from a range of countries and settings. Six studies were longitudinal; no longitudinal studies followed patients beyond hospital discharge. Prevalence varied between 5 and 84% with a median of 31%, with a relationship to setting: pooled ESBL-E colonisation in community studies was 18% (95% CI 12 to 28, 12 studies); in studies recruiting people at admission to hospital colonisation was 32% (95% CI 24 to 41% 8 studies); and for inpatients, colonisation was 55% (95% CI 49 to 60%, 7 studies). Antimicrobial use was associated with increased risk of ESBL-E colonisation, and protected water sources or water treatment by boiling may reduce risk.

Conclusions: ESBL-E colonisation is common in sSA, but how people become carriers and why is not well understood. To inform the design of interventions to interrupt transmission in this setting requires longitudinal, community studies.

Item Type:	Article
Subjects:	QW Microbiology and Immunology > Bacteria > QW 131 Gram-negative bacteria. QW Microbiology and Immunology > Bacteria > QW 138 Enterobacteriaceae QW Microbiology and Immunology > QW 45 Microbial drug resistance. General or not elsewhere classified. W General Medicine. Health Professions > W 20.5 Biomedical research WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.12688/wellcomeopenres.15514.2
Depositing User:	Joseph Lewis
Date Deposited:	26 Nov 2019 10:37
Last Modified:	07 Feb 2020 09:56
URI:	https://archive.lstmed.ac.uk/id/eprint/13137

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