BACKGROUND Antimicrobial resistance is a serious public health problem. Fecal carriage of drug-resistant bacteria has been suggested as an important source of antimicrobial resistant genes (ARGs). We aimed to identify risk factors associated with fecal carriage of drug-resistant commensal Escherichia coli among healthy adult population. METHODS We conducted a systematic review and meta-analysis following the PRISMA guideline. We identified observational studies published from 2014 to 2019 through PubMed, Embase, and Web of Science. Studies were eligible if they investigated and reported risk factors and accompanying measure of associations for fecal carriage of drug-resistant E. coli for healthy population aged 18-65. Data on risk factors assessed in three or more studies were extracted. RESULTS Fifteen of 395 studies involving 11480 healthy individuals were included. The pooled prevalence of drug-resistant Enterobacteriaceae was 14% (95% confidence interval [CI] 8-23%). Antimicrobial use within the 12 months prior to stool culture (odds ratio [OR] 1.84 [95%CI 1.35-2.51]), diarrhea symptoms (OR 1.56 [95%CI 1.09-2.25]), travel to India (OR 4.15 [95%CI 2.54-6.78]), and vegetarian diet (OR 1.60 [95%CI 1.00(1.0043)-2.56(2.5587)]) were associated with increased risk of fecal carriage of drug-resistant E. coli. Among travellers, antimicrobial use (OR 2.81 [95%CI 1.47-5.36]), diarrhea symptoms (OR 1.65 [95%CI 1.02-2.68]), travel to India (OR 3.80 [95%CI 2.23-6.47]), and vegetarian diet (OR 1.92 [95%CI 1.13-3.26]) were associated with increased risk. Among general adult population, antimicrobial use (OR 1.51 [95%CI 1.17-1.94]), diarrhea symptoms (OR 1.53 [95%CI 1.27-1.84]), and travel to Southeast Asia (OR 1.67 [95%CI 1.02-2.73]) were associated with the increased risk of drug-resistant E. coli carriage. CONCLUSIONS The findings indicate that dietary habit as well as past antimicrobial use and travel to high-risk country are associated with the risk of fecal carriage of drug-resistant commensal E. coli.

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粪便携带抗药性大肠杆菌的危险因素：系统评价和荟萃分析。

背景技术抗菌素耐药性是严重的公共卫生问题。已建议粪便携带抗药性细菌作为抗药性抗性基因（ARG）的重要来源。我们旨在确定健康成年人群中与粪便携带抗药性共生大肠杆菌有关的危险因素。方法我们按照PRISMA指南进行了系统的回顾和荟萃分析。我们确定了2014年至2019年通过PubMed，Embase和Web of Science发表的观察性研究。如果研究调查并报告了18-65岁健康人群的粪便携带抗药性大肠杆菌的相关危险因素和相关措施，则该研究是合格的。提取了在三个或更多研究中评估的危险因素数据。结果395项研究中有15项涉及11480名健康个体。耐药性肠杆菌科细菌的合并患病率为14％（95％置信区间[CI] 8-23％）。粪便培养前12个月内使用抗菌药物（几率[OR] 1.84 [95％CI 1.35-2.51]），腹泻症状（OR 1.56 [95％CI 1.09-2.25]），前往印度（OR 4.15 [95] ％CI 2.54-6.78]）和素食（OR 1.60 [95％CI 1.00（1.0043）-2.56（2.5587）]）与粪便携带抗药性大肠杆菌的风险增加相关。在旅行者中，使用抗菌药物（OR 2.81 [95％CI 1.47-5.36]），腹泻症状（OR 1.65 [95％CI 1.02-2.68]），前往印度（OR 3.80 [95％CI 2.23-6.47]）和素食（OR 1.92 [95％CI 1.13-3.26]）与患病风险增加相关。在一般成年人口中，使用抗菌药物（OR 1.51 [95％CI 1.17-1.94]），腹泻症状（OR 1.53 [95％CI 1.27-1.84]）和前往东南亚（OR 1.67 [95％CI 1.02-2.73]）与耐药性大肠杆菌运输的风险增加有关。结论研究结果表明，饮食习惯以及过去的抗菌药物使用和前往高危国家的旅行与粪便携带抗药性大肠杆菌的风险有关。