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

Abstract

ABSTRACTBackgroundRacial 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 antimicrobial-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.MethodsWe 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.ResultsFifty-four observational studies in 59 publications met our inclusion criteria. Studies reported results forStaphylococcus aureus(n=56),Escherichia coli(n=8), Pseudomonas aeruginosa(n=2), Enterobacterales (n=1),Enterococcus faecium(n=1), andKlebsiella pneumoniae(n=1), and were conducted in the USA (n=42), Israel (n=5), New Zealand (n=4), Australia (n=2), and Brazil (n=1). USA studies most often examined Black and Hispanic minority groups and regularly reported a higher risk of these pathogens in Black persons and mixed results for Hispanic persons. Ethnic minority groups were often reported to be at a higher risk in other countries.ConclusionSufficient evidence was identified to justify systematic reviews and meta-analyses evaluating the relationship between race, ethnicity, and community-acquiredS. aureusandE. coli,although data were rare for other pathogens. We recommend that future studies clarify whether race and ethnicity data are self-reported, collect race and ethnicity data in conjunction with the social determinants of health, and make a concerted effort to include non-English speakers and Indigenous populations from the Americas, when possible.