A systematic review and meta-analysis of the global epidemiology of carbapenem-resistant Escherichia coli.

Among drug-resistant strains, Escherichia coli is estimated to cause the largest number of deaths per year, globally. This study aimed to estimate the global prevalence of carbapenem-resistant E. coli through a systematic review and meta-analysis of the available literature. Three databases, Embase, PubMed, and Scopus were screened for original research articles reporting the epidemiology of carbapenem-resistant E. coli between 2019 and 2023. Following data extraction, a meta-analysis was performed using the random effects model for overall prevalence and prevalence of key carbapenemase enzymes (NDM, OXA, IMP, VIM, and KPC). This systematic review was registered with PROSPERO (CRD42023433370). A total of 44 studies were included in this review, spanning 16 countries over five WHO regions, with a pooled global prevalence of carbapenem-resistant E. coli at 7 % (95 % CI 0.01; 0.31). The highest pooled prevalence was 51 % (95 % CI 43 % to 58 %) for Bangladesh, and the lowest was 0.15 % (95 % CI 0.08 % to 0.23 %) for Australia. NDM was the most frequent E. coli carbapenemase identified, followed by OXA, KPC, VIM, and IMP. This study found that the prevalence of carbapenem-resistance amongst E. coli populations is highly variable between countries and significantly lacking in most, suggesting an increased need for robust global surveillance.