ABSTRACT

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.

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.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

Research reported in this publication was supported by the National Institute of Allergy and Infectious Diseases of the National Institutes of Health under Award Number UM1AI104681. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Funders had no role in study design; in the collection, analysis, or interpretation of data; on in writing the manuscript. Funders had no role in study design; in the collection, analysis, or interpretation of data; on in writing the manuscript. CWC was supported by an IDSA Foundation and HIV Medicine Association Grants for Emerging Research/Clinician Mentorship (G.E.R.M.) Program Award. The ARLG Publications Committee reviewed the manuscript prior to submission for publication.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Footnotes

Data Availability

All data produced in the present work are contained in the manuscript.

ABBREVIATIONSAMRAntimicrobial resistanceATSIAboriginal and Torres Strait IslanderCACommunity-acquiredCA-AMRCommunity-acquired antimicrobial resistanceCAPCommunity-acquired pneumoniaCRECarbapenem-resistant EnterobacteralesESBLExtended Spectrum Beta-LactamaseESKAPEEnterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.MDRMulti-drug resistantMICMinimum inhibitory concentrationMRSAMethicillin-resistant Staphylococcus aureusMSSAMethicillin-Sensitive Staphylococcus aureusP. aeruginosaPseudomonas aeruginosaS. aureusStaphylococcus aureusSESSocioeconomic StatusSSTISkin and soft tissue infectionsUSAUnited States of AmericaUTIUrinary Tract Infection