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

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

We conducted an electronic literature search of MEDLINE, Daily, Global Health, Embase, Cochrane Central and Web of Science from inception to March 2024 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.

62 observational studies in 68 publications met our inclusion criteria. Studies reported results for Staphylococcus aureus (n=61), Escherichia coli (n=9), Pseudomonas aeruginosa (n=2), Enterobacterales (n=1), Enterococcus faecium (n=1) and Klebsiella pneumoniae (n=1) and were conducted in the USA (n=48), Israel (n=6), New Zealand (n=4), Australia (n=3) and Brazil (n=1). US 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.

Sufficient evidence was identified to justify systematic reviews and meta-analyses evaluating the relationship between race, ethnicity and community-acquired S. aureus and E. 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.