Global landscape of community carriage of antimicrobial resistant bacterial pathogens: protocol for a systematic review and meta-analysis

Abstract Background Community carriage of antimicrobial resistant (AMR) bacterial pathogens among healthy individuals can serve as a reservoir for resistance genes and contribute to the development of resistant community-acquired infections. However, the global epidemiology of community AMR carriage remains poorly characterized, with existing studies showing substantial geographic and methodological heterogeneity. This systematic review and meta-analysis aims to estimate the global pooled prevalence of AMR carriage among community populations for pathogens listed in the WHO 2024 Bacterial Priority Pathogens List. Methods This study will follow the PRISMA-P guidelines. We will search electronic databases including PubMed/MEDLINE, Embase, Web of Science, CINAHL Complete, Scopus, CNKI, Wanfang, and the WHO Global Index Medicus, for publications in English, French, Spanish, or Mandarin, without date restrictions. The primary outcome will be the prevalence of resistance among selected pathogens from the World Health Organization’s (WHO) 2024 Bacterial Priority Pathogens List (BPPL), isolated from various sample types collected from the general population. Study selection will be aided by Rayyan, and conducted by two independent reviewers with defined criteria. Data synthesis will include meta-analysis to calculate pooled prevalence estimates with 95% confidence intervals, assessment of heterogeneity using I 2 statistics, and pre-specified subgroup analyses by geographic region, pathogen type, and time period. Risk of bias will be assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Epidemiological Studies. Results will be presented using forest plots, summary tables, and narrative syntheses. Sensitivity analyses will be conducted to assess the robustness of findings. Expected outcomes The primary outcome will be pooled prevalence estimates of community AMR carriage for priority bacterial pathogens, stratified by geographic region, pathogen type, and time period. Secondary objectives include identifying temporal trends, evaluating the influence of environmental and socio-economic factors, and characterizing resistance patterns including multidrug resistance. The findings will map global patterns of community AMR carriage, highlight knowledge gaps, and inform evidence-based public health strategies for AMR prevention and control. Systematic review registration The protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42024576960 (registered on 11th February 2025).