Comparison of diarrheagenic Escherichia coli pathotypes in diarrheic and non-diarrheic under-five children: a systematic review and meta-analysis

Abstract

Abstract Introduction Diarrhea remains one of the leading causes of morbidity and mortality in under-five children (UFC). Diarrheagenic Escherichia coli (DEC) is associated with UFC diarrhea. Clear diagnosis of DEC is limited due to shared virulence genes with non-pathogenic strains. The study aimed to assess if or whether DEC is more associated with diarrheic than non-diarrheic UFC. Methods The updated PRISMA guideline was followed for this systematic review and meta-analysis. The protocol is registered in PROSPERO (CRD420261294236). The aim of the study was to assess the role of DEC pathotypes in diarrhea of UFC globally. Major databases using predetermined criteria were used to identify relevant articles and managed by EndNote. The statistical analysis was done using STATA 17.0. Pooled effect (Log (OR), heterogeneity evaluation, and publication bias were done. Cumulative meta-analysis with prediction intervals was also done. Results A total of 15 studies involving 15,815 participants (7,849 diarrhea cases and 7,766 controls) were included in this review. EIEC was significantly associated with UFC diarrhea (OR = 1.54 with 95% CI: 1.02–2.32) in the present study. EAEC, EPEC, ETEC, and STEC showed positive association but largely were non-significant. Minimal effect (OR = 0.96), heterogeneity (I² = 88%), and wide prediction intervals (PI) was for EAEC revealing variable impacts across populations. EPEC (OR = 1.11), STEC (OR = 1.11), and ETEC (OR = 1.25) showed non-significant association with moderate to high heterogeneity. Context-specific association was seen for all the DEC pathotypes in the subgroup analysis. The heterogeneity and inconsistent finding could be due to variation in publication year, geographic location, detection methods, and virulence gene targets. Conclusion Only EIEC was significantly and consistently associated with UFC diarrhea. Strengthened surveillance system and the implementation of targeted diagnostic methods are strongly recommended.