title: Fecal Colonization With Extended-spectrum Beta-lactamase-Producing Enterobacteriaceae and Risk Factors Among Healthy Individuals: A Systematic Review and Metaanalysis.
abstract: Gut colonization is a risk factor for infections with extended-spectrum beta-lactamase (ESBL)-producing organisms. We aimed to determine the ESBL class A reservoir among healthy individuals.
  
  
  
  We searched PubMed and EMBASE (through 10 July 2015) looking for studies that contained data for fecal colonization with ESBL class A bacteria among healthy individuals for each World Health Organization-defined region. Distribution of isolates among cefotaximase (CTX-M), sulfhydryl variable, and temoneira enzymes and data on previous antibiotic use, international travel, previous hospitalization, and animal contacts were extracted.
  
  
  
  Sixty-six of 17 479 studies on 28 909 healthy individuals were included. The pooled prevalence of ESBL class A colonization was 14% (95% confidence interval [CI], 9, 20), with an increasing trend of 5.38% annually (P = .003). The pooled prevalence was higher in Asia and Africa (ranging from 46%, 95% CI, 29, 63 to 15%, 95% CI, 4, 31) and lower but still significant in central (3%, 95% CI, 1, 5), northern (4%, 95% CI, 2, 6), and southern Europe (6%, 95% CI, 1, 12) and the Americas (2%, 95% CI, 0, 5). CTX-Ms were the prevalent ESBL enzyme (69%). Antibiotic use for the prior 4 or 12 months was associated with a high colonization risk (risk ratio [RR] = 1.63; 95% CI, 1.19, 2.24 and RR = 1.58; 95% CI, 1.16, 2.16, respectively). International travel was also correlated with ESBL colonization [(RR = 4.06, (95% CI, 1.33, 12.41)].
  
  
  
  The ESBL colonization rate among healthy individuals is significant worldwide. This should be taken into consideration in infection control and antibiotic management decisions.
authors.affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Styliani
authors.initials: S
authors.lastname: Karanika
authors.affiliation: General Internal Medicine Section, Boston Medical Center, Boston University School of Medicine, Massachusetts.
authors.forename: Theodoros
authors.initials: T
authors.lastname: Karantanos
authors.affiliation: General Internal Medicine Section, Boston Medical Center, Boston University School of Medicine, Massachusetts.
authors.forename: Marios
authors.initials: M
authors.lastname: Arvanitis
authors.affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Christos
authors.initials: C
authors.lastname: Grigoras
authors.affiliation: Infectious Diseases Division, Warren Alpert Medical School of Brown University, Providence, Rhode Island.
authors.forename: Eleftherios
authors.initials: E
authors.lastname: Mylonakis
mesh_terms: D000349:Africa / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001208:Asia / Q000453:epidemiology; D004755:Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005060:Europe / Q000453:epidemiology; D005243:Feces / Q000382:microbiology; D006801:Humans; D015995:Prevalence; D014195:Travel; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; C071167:beta-lactamase CTX-2; D001618:beta-Lactamases
keywords: ESBL fecal colonization; community; healthy population; metaanalysis; risk factors