Race and ethnicity as risk factors for colonization and infection with key bacterial pathogens: a scoping review

Background

Racial and ethnic disparities in infectious disease burden have been reported in the USA and globally, most recently for COVID-19. It remains unclear whether such disparities also exist for priority bacterial pathogens that are increasingly antibiotic-resistant. We conducted a scoping review to summarize published studies that report on colonization or community-acquired infection with pathogens among different races and ethnicities.

Methods

We conducted an electronic literature search of MEDLINE®, Daily, Global Health, Embase, Cochrane Central, and Web of Science from inception to January 2022 for eligible observational studies. Abstracts and full-text publications were screened in duplicate for studies that reported data for race or ethnicity for at least one of the pathogens of interest.

Results

Fifty-four observational studies in 59 publications met our inclusion criteria. Studies reported results for Enterobacterales, Enterococcus faecium, Escherichia coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus , and were conducted in Australia, Brazil, Israel, New Zealand, and USA. USA studies most often examined Black and Hispanic minority groups with studies regularly reporting a higher risk of these pathogens in Black persons and mixed results for Hispanic persons. Ethnic minority groups (e.g. Bedouins in Israel, Aboriginals in Australia) were often reported to be at a higher risk in other countries.

Conclusion

Sufficient evidence was identified in this scoping review justifying future systematic reviews and meta-analyses evaluating the relationship between community-acquired pathogens and race and ethnicity. However, we noted that only a fraction of studies reported data stratified by race and ethnicity, highlighting a substantial gap in the literature.

RESEARCH IN CONTEXT

Evidence before this study

Racial and ethnic disparities in colonization and community-acquired infection with key bacterial pathogens have previously been reported, but global evidence has not been compiled to date. Literature was searched for in MEDLINE, Daily, Global Health, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection from inception through January 2022, utilizing MeSH terminology and keywords for Community-Acquired Infections, Outpatients, Ambulatory Care, Socioeconomic Factors, Health Status Disparities, Healthcare Disparities, Continental Population Groups, Ethnic Groups, Gram-Negative Bacteria, and individual ESKAPE pathogens.

Added value of this study

To the best of our knowledge, this is the first compilation of global evidence for racial and ethnic disparities in colonization/infection with priority bacterial pathogens that are increasingly antimicrobial-resistant (AMR). While most studies we included were conducted in the USA, we also identified relevant studies from Brazil, Israel, Australia, and New Zealand. In general, persons belonging to racial or ethnic minority groups within these countries – especially Black persons in the USA and Brazil, Aboriginal persons in Australia and New Zealand, and Arabs or Bedouins persons in Israel - were at higher risk for colonization/infection with the pathogens of interest compared to majority groups, despite there being no biological basis for such differences. We identified several gaps that merit consideration in future studies, including incongruent classifications of race and ethnicity across studies, limited research among Indigenous and First Nations populations in the US, Canada, and Central and South America, and a lack of studies that reported colonization or infection rates stratified by individuals’ race or ethnicity.

Implications of all the available evidence

Our findings indicate that global efforts to equitably prevent, diagnose, and treat bacterial infections that are increasingly AMR will be challenging unless strategies that account for racial and ethnic disparities are considered.