Global Prevalence of Escherichia coli Infection in Cockroaches: A Systematic Review and Meta-Analysis

Abstract

Background: Cockroaches are mechanical vectors of Escherichia coli, a key indicator of fecal contamination and anti­microbial resistance. Their presence in hospitals and households poses risks of healthcare‑associated and communi­ty‑acquired infections. However, no global quantitative prevalence estimate of E. coli in cockroaches is available. We systematically reviewed and meta-analyzed observational studies to estimate pooled global prevalence of E. coli in cockroaches and explore heterogeneity by site, species, and region.
Methods: We systematically searched PubMed, Scopus, Web of Science and Embase for observational studies report­ing E. coli prevalence in cockroaches (last search: January, 2026), without geographical or time restrictions. Pooled prevalence was estimated using a DerSimonian–Laird random‑effects model with Freeman‑Tukey double arcsine trans­formation. Subgroup analyses were predefined by sampling site, cockroach species and country. Heterogeneity was assessed using the I² statistic. The protocol was not registered in the International Prospective Register of Systematic Reviews (PROSPERO).
Results: The pooled global prevalence of E. coli colonization was 22.6%. In subgroup analyses, the highest and lowest prevalence of E. coli colonization were found in studies with external surface sampling (26.5%) and internal parts sam­pling (16.8%), respectively. The pooled prevalence of E. coli colonization in studies with American and German cock­roaches was 28.4% and 18.2 %, respectively. A significant difference was observed between these subsets of studies.
Conclusions: This meta‑analysis reveals a substantial prevalence of E. coli contamination in cockroaches, particularly on external surfaces, in Periplaneta americana and in hospital/household settings. Further research is needed to develop targeted interventions for reducing associated public health risks.