Prevalence, risk factors for and trends in faecal colonisation by extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) in the community in Spain: A cross-sectional study and meta-analysis

Objectives

To determine the prevalence of and risk factors for extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-PE) faecal carriage among healthy volunteers from Barcelona, and to estimate the pooled prevalence in the community in Spain.

Methods

University students were asked to complete a questionnaire and provide a rectal swab, which was tested for ESBL-producing, ciprofloxacin- and trimethoprim–sulfamethoxazole-resistant Enterobacterales. Risk factors for carriage of antimicrobial resistance were identified by multivariate logistic regression. To place these results in the appropriate context, a systematic literature search was conducted to retrieve articles containing data on the prevalence of ESBL-PE faecal carriage in the community in Spain. To obtain the pooled prevalence, a random-effects meta-analysis was performed.

Results

One hundred and thirty-five of 214 participants were included in the analysis. Faecal carriage of Escherichia coli/Klebsiella pneumoniae (E/K) resistant to at least one of the antibiotics tested was found in 32 participants (23.7%). Fourteen subjects carried ESBL-E/K (10.4%), with the CTX-M type being the most prevalent (85.7%). Risk factors for ESBL carriage were travel to a high-risk region in the past 3 years (OR 5.66; 95% CI 1.07–29.9) and living in a crowded city district (OR 6.91; 95% CI 1.22–39.08). Thirteen articles covering 21,760 individuals from Spain were included in the meta-analysis, giving a pooled prevalence rate for ESBL-PE carriage in the community of 5.8% (95% CI 4.1–7.8%), and a steady increase per year.

Conclusions

The faecal colonisation prevalence by ESBL-PE among healthy individuals in Spain is high. It is associated with international travel and living in crowded city districts.