Prevalence of Listeria monocytogenes in Select Ready-to-Eat Foods-Deli Meat, Soft Cheese, and Packaged Salad: A Systematic Review and Meta-Analysis.

Listeria monocytogenes is the cause of listeriosis, an important foodborne disease. Contaminated ready-to-eat foods are common sources of L. monocytogenes, yet no global estimates exist for prevalence and levels in high-risk ready-to-eat foods. Our objective was to estimate the prevalence and levels of L. monocytogenes in deli meat, soft cheese, and packaged salad. We searched Medline, Web of Science, Agricola, Conference Proceedings Citation Index-Science, Science.gov, ScienceResearch.com , and OpenGREY for studies on L. monocytogenes prevalence and/or levels, with no restriction on publication date. We used a priori study selection, data extraction, and risk of biases processes. Results were synthesized with random-effects meta-analyses and meta-regressions to evaluate heterogeneity between studies. We included in the review 100 studies with a sample size restriction of ≥100, and we estimated L. monocytogenes prevalence in deli meat at 2.9% (95% confidence interval [CI], 2.3 to 3.6%), in soft cheese at 2.4% (95% CI, 1.6 to 3.6%), and in packaged salad at 2.0% (95% CI, 1.2 to 3.1%). High heterogeneity was present in all food groups, and meta-regressions did not reveal consistent explanations for heterogeneity. Pathogen level was not reported consistently or in the format required for synthesis, so meta-analyses of this variable were not performed. The high heterogeneity between studies indicates that use of global summary prevalence estimates for risk assessments are not advisable, but awareness of risk and the heterogeneity of the risk is relevant for education and further risk assessment.