Tehran University of Medical Sciences Journal of Arthropod-Borne Diseases 2322-1984 0 0 2026 09 30 1882 1882 Maryam Hatamibardar Student Research Committee, Babol University of Medical Sciences, Babol, Iran Mahdi Sepidarkish Department of Biostatistics and Epidemiology, School of Public Health, Babol University of Medical Sciences, Babol, Iran Yasaman Dini Student Research Committee, Babol University of Medical Sciences, Babol, Iran Fatemeh Ramezani Student Research Committee, Babol University of Medical Sciences, Babol, Iran Sina Nasrollahian Department of Bacteriology and Virology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran Mehrdad Halaji Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Mohsen Karami Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran 2025 10 20 2026 09 19 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. https://jad.tums.ac.ir/index.php/jad/article/view/1882 https://jad.tums.ac.ir/index.php/jad/article/download/1882/745 https://jad.tums.ac.ir/index.php/jad/article/download/1882/746