Community human-to-human transmission of multidrug resistant Enterobacterales in high-income countries: a systematic review
Résumé
Background: Human-to-human transmission of multidrug-resistant Enterobacterales (MDRE) in community settings of high-income countries (HICs) is poorly documented Objectives: This systematic review examines current available evidence regarding (i) human reservoirs of MDRE in community settings of HICs, (ii) dynamics of human-to-human transmission, and (iii) intervention opportunities. Methods: A systematic search was conducted in PubMed, Cochrane, EMBASE, SCOPUS, and Web of Science was searched up to end 2024. Articles related to community-acquired MDRE, human transmission, fecal carriage, antimicrobial resistance were included. We excluded articles on low and middle-income countries, on nursing homes and hospital-based studies. Results: A total of 105 articles were included. Prevalence estimates of Extended Spectrum BetaLactamases-Enterobacteriaceae carriage in the community increased over time (from 3.2% [IQR 2.1] (median [interquartile range]) in 2002-2009, to 19.3% [IQR 9.8] in 2018-2021), and the highest prevalence were reported in Eastern Mediterranean countries (13.5% [IQR 1.2]), followed by Western Pacific Regions (12.5% [IQR 15.2]). Prevalence of carriage among household members of an index carrier ranged from 8-37%. Few data were reported on infection control interventions to prevent community MDRE transmission. The impact of antimicrobial stewardship programs on antimicrobial resistance is unknown. Conclusion: Data on dynamics of MDRE transmission in the community of HICs are scarce. Targeted studies, and evaluation of interventions, are needed in the community.
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