Investigating the burden of antibiotic resistance in ethnic minority groups in high-income countries: protocol for a systematic review and meta-analysis.
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Author(s)
Type
Journal Article
Abstract
Background: Antibiotic resistance (ABR) is an urgent problem globally, with overuse and misuse of antibiotics
being one of the main drivers of antibiotic-resistant infections. There is increasing evidence that the burden of
community-acquired infections such as urinary tract infections and bloodstream infections (both susceptible and
resistant) may differ by ethnicity, although the reasons behind this relationship are not well defined. It has been
demonstrated that socioeconomic status and ethnicity are often highly correlated with each other; however, it is
not yet known whether accounting for deprivation completely explains any discrepancy seen in infection risk. There
have currently been no systematic reviews summarising the evidence for the relationship between ethnicity and
antibiotic resistance or prescribing.
Methods: This protocol will outline how we will conduct this systematic literature review and meta-analysis
investigating whether there is an association between patient ethnicity and (1) risk of antibiotic-resistant infections
or (2) levels of antibiotic prescribing in high-income countries. We will search PubMed/MEDLINE, EMBASE, Global
Health, Scopus and CINAHL using MESH terms where applicable. Two reviewers will conduct title/abstract screening,
data extraction and quality assessment independently. The Critical Appraisal Skills Programme (CASP) checklist will be
used for cohort and case-control studies, and the Cochrane collaboration’s risk of bias tool will be used for randomised
control trials, if they are included. Meta-analyses will be performed by calculating the minority ethnic group to majority
ethnic group odds ratios or risk ratios for each study and presenting an overall pooled odds ratio for the two outcomes.
The Grading of Recommendations, Assessments, Development and Evaluation (GRADE) approach will be used to assess
the overall quality of the body of evidence.
Discussion: In this systematic review and meta-analysis, we will aim to collate the available evidence of whether there is
a difference in rates of AMR and/or antibiotic prescribing in minority vs. majority ethnic groups in high-income countries.
Additionally, this review will highlight areas where more research needs to be conducted and may provide insight into
what may cause differences in this relationship, should they be seen.
Systematic review registration: PROSPERO (CRD42016051533)
being one of the main drivers of antibiotic-resistant infections. There is increasing evidence that the burden of
community-acquired infections such as urinary tract infections and bloodstream infections (both susceptible and
resistant) may differ by ethnicity, although the reasons behind this relationship are not well defined. It has been
demonstrated that socioeconomic status and ethnicity are often highly correlated with each other; however, it is
not yet known whether accounting for deprivation completely explains any discrepancy seen in infection risk. There
have currently been no systematic reviews summarising the evidence for the relationship between ethnicity and
antibiotic resistance or prescribing.
Methods: This protocol will outline how we will conduct this systematic literature review and meta-analysis
investigating whether there is an association between patient ethnicity and (1) risk of antibiotic-resistant infections
or (2) levels of antibiotic prescribing in high-income countries. We will search PubMed/MEDLINE, EMBASE, Global
Health, Scopus and CINAHL using MESH terms where applicable. Two reviewers will conduct title/abstract screening,
data extraction and quality assessment independently. The Critical Appraisal Skills Programme (CASP) checklist will be
used for cohort and case-control studies, and the Cochrane collaboration’s risk of bias tool will be used for randomised
control trials, if they are included. Meta-analyses will be performed by calculating the minority ethnic group to majority
ethnic group odds ratios or risk ratios for each study and presenting an overall pooled odds ratio for the two outcomes.
The Grading of Recommendations, Assessments, Development and Evaluation (GRADE) approach will be used to assess
the overall quality of the body of evidence.
Discussion: In this systematic review and meta-analysis, we will aim to collate the available evidence of whether there is
a difference in rates of AMR and/or antibiotic prescribing in minority vs. majority ethnic groups in high-income countries.
Additionally, this review will highlight areas where more research needs to be conducted and may provide insight into
what may cause differences in this relationship, should they be seen.
Systematic review registration: PROSPERO (CRD42016051533)
Date Issued
2017-12-11
Date Acceptance
2017-11-30
Citation
Systematic Reviews, 2017, 6
ISSN
2046-4053
Publisher
BioMed Central
Journal / Book Title
Systematic Reviews
Volume
6
Copyright Statement
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver
(http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
License URL
Sponsor
National Institute for Health Research
National Institute for Health Research
Grant Number
HPRU-2012-10047
HPRU-2012-10047
Subjects
Antibiotic prescribing
Antibiotic resistance
Community-acquired infections
Ethnicity
Healthcare-associated infections
High-income countries
Meta-analysis
Systematic review
Publication Status
Published
Article Number
251