One Health perspective on prevalence of co-existing extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae: a comprehensive systematic review and meta-analysis

Background The Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) bacterial isolates that produce extended-spectrum beta-lactamases (ESBLs) contribute to global life-threatening infections. This study conducted a systematic review and meta-analysis on the global prevalence of ESBLs in co-existing E. coli and K. pneumoniae isolated from humans, animals and the environment. Methods The systematic review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) [ID no: CRD42023394360]. This study was carried out following the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. One hundred and twenty-six eligible studies published on co-existing antibiotic resistance in E. coli and K. pneumoniae between 1990 and 2022 were included. Results The pooled prevalence of ESBL-producing E. coli and K. pneumoniae was 33.0% and 32.7% for humans, 33.5% and 19.4% for animals, 56.9% and 24.2% for environment, 26.8% and 6.7% for animals/environment, respectively. Furthermore, the three types of resistance genes that encode ESBLs, namely bla(SHV)bla(CTX-M),bla(OXA), and bla(TEM), were all detected in humans, animals and the environment. Conclusions The concept of One-Health surveillance is critical to tracking the source of antimicrobial resistance and preventing its spread. The emerging state and national surveillance systems should include bacteria containing ESBLs. A well-planned, -implemented, and -researched alternative treatment for antimicrobial drug resistance needs to be formulated.

Automated summary

This study investigated the global prevalence of extended-spectrum beta-lactamases (ESBLs) in co-existing Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) isolates from humans, animals, and the environment. Three types of resistance genes encoding ESBLs were detected in all three sources. The concept of One-Health surveillance is crucial in tracking and preventing the spread of antimicrobial resistance, and alternative treatment for antimicrobial drug resistance needs to be developed.