# Cockroaches as Vectors of Pathogens and Antimicrobial Resistance: Evidence from Healthcare, Community, and Agricultural Settings

## TL;DR

Cockroaches spread dangerous microbes and antibiotic-resistant bacteria in hospitals, homes, and farms, highlighting the need for better pest control and research.

## Contribution

This review synthesizes evidence on cockroach roles in spreading pathogens and antimicrobial resistance, emphasizing integrated pest management and research priorities.

## Key findings

- Cockroaches carry multidrug-resistant bacteria and pathogens from contaminated environments to clean areas.
- They contribute to spreading antimicrobial resistance in healthcare and food systems.
- Research is needed on cockroach-derived antimicrobials and their microbiota interactions.

## Abstract

Cockroaches, particularly the German cockroach and American cockroach, are common pests found in hospitals, homes, food facilities, and farms. These insects can carry dangerous bacteria, fungi, and parasites on their bodies and in their digestive systems, including drug-resistant “superbugs” that do not respond to common antibiotics. Cockroaches pick up these harmful microorganisms from sewage, garbage, contaminated food, and hospital environments, then spread them to clean surfaces, food, and medical equipment through contact, their droppings, and regurgitated material. In hospitals, cockroaches can move germs from dirty areas like drains and waste rooms to vulnerable patient units such as intensive care wards and burn units, potentially causing serious infections. In food production and livestock facilities, they can contaminate food products and spread disease along supply chains. This review examines current scientific evidence showing how cockroaches spread pathogens and antimicrobial resistance and calls for stronger pest control measures in healthcare, food safety programmes, and disease surveillance systems. The review also discusses the need for more research on how microorganisms interact with cockroaches and how to safely study potential antimicrobial compounds that cockroaches produce, which might one day help develop new antibiotics.

Synanthropic cockroaches, especially Blattella germanica and Periplaneta americana, are persistent pests of human dwellings, healthcare facilities, food establishments, farms, and transport infrastructure. Accumulating field and laboratory studies indicate that synanthropic cockroaches carry clinically important bacteria, fungi, and parasites, including multidrug-resistant strains harbouring extended-spectrum β-lactamase, carbapenemase, and other antimicrobial-resistant determinants. Cockroaches acquire these organisms from sewage, waste, food residues, animal excreta, and contaminated clinical environments, and retain them on the cuticle and within a complex gut microbiota. Dissemination is predominantly mechanical, via contact transfer and deposition of regurgitate and faeces on food, equipment, and surfaces, but may be amplified by gut colonisation, microbial interactions, and horizontal gene transfer within the cockroach microbiome. In hospitals, cockroaches can connect high-burden reservoirs (drains, waste areas, kitchens) with vulnerable units, including intensive care units (ICUs), neonatal intensive care units (NICUs), burn units, and haemato-oncology wards. In food and livestock systems, they may contaminate housing, ingredients, and finished products, enabling spillover along supply chains and at ports. This review synthesises current evidence and highlights the following priorities: integrate cockroaches into infection prevention, food safety, and biosecurity; incorporate cockroach sampling into antimicrobial resistance (AMR) and genomic surveillance; and advance mechanistic research on cockroach–microbiota–pathogen interactions to improve pest management and safely explore cockroach-derived antimicrobial compounds. In this review, we distinguish external mechanical carriage (cuticular contamination) from internal gut carriage; we use “gut colonisation” only when persistence/replication or prolonged shedding is demonstrated.