Antimicrobial Resistance Associated with Mass Gatherings: A Systematic Review

Area of Science:

• Public Health
• Infectious Diseases
• Microbiology

Background:

• Mass gatherings are recognized as potential hotspots for communicable disease transmission.
• Emerging evidence suggests a link between attending mass gatherings and the acquisition of antimicrobial resistance (AMR).

Purpose of the Study:

• To systematically review and synthesize existing evidence on the association between mass gathering attendance and AMR.
• To assess the prevalence of AMR in pathogens commonly found at mass gatherings.

Main Methods:

• A comprehensive literature search was conducted across major databases (Cochrane, Medline, Scopus, Embase).
• Studies reporting original data on mass gatherings and AMR outcomes were included.
• A narrative synthesis was performed due to study heterogeneity, precluding meta-analysis.

Main Results:

• Forty-four studies met the inclusion criteria, with most focusing on religious mass gatherings.
• Significant increases in antibiotic-resistant Escherichia coli and Klebsiella pneumoniae were observed post-Hajj.
• Elevated carriage of extended-spectrum β-lactamase (ESBL) or carbapenemase genes and non-susceptible Streptococcus pneumoniae isolates were reported.

Conclusions:

• Attendance at mass gatherings is associated with the acquisition of specific antimicrobial resistance phenotypes and genotypes.
• Pathogens such as E. coli and S. pneumoniae demonstrate increased resistance post-attendance.
• Further research is needed to understand the full scope and implications of AMR transmission at mass gatherings.