Comparative Performance and Species-Specific Recovery Biases of Culture-Based Methods for Campylobacter Detection in Food Products: A Systematic Review and Meta-Analysis.

Campylobacter is the primary bacterial cause of foodborne gastroenteritis globally. While international standards recommend a tiered approach for detection, emerging evidence suggests that selective protocols may introduce species-specific recovery biases. This systematic review and meta-analysis evaluated the diagnostic performance of established culture-based detection protocols across diverse food matrices. Following PRISMA 2020 guidelines, we searched multiple databases for studies reporting 2 × 2 diagnostic accuracy data through October 2024. Ten studies comprising 43 method comparisons and 4599 samples met the inclusion criteria. The overall pooled sensitivity was 95.8% (95% CI: 93.6-97.4%), and the specificity was 90.2% (95% CI: 86.8-92.9%). Even with a limited number of comparisons (n = 2), direct culture demonstrated high diagnostic sensitivity (99.1%) and significantly faster turnaround times. Crucially, selective enrichment exhibited a profound species-specific bias: C. jejuni showed 59.4 percent lower recovery than C. coli in Bolton broth, likely due to differential polymyxin B susceptibility. These findings highlight the importance of context-dependent method selection within the ISO 10272-1:2017 framework, suggesting that direct culture (Procedure C) should be prioritized for high-contamination matrices to ensure unbiased recovery of C. jejuni. Large-scale multicenter validation is warranted to confirm these exploratory findings for direct culture.