Global prevalence of human intestinal carriage of ESBL-producing E. coli during and after the COVID-19 pandemic

Background There is a pressing need for global surveillance of ESBL-producing Escherichia coli due to its health impacts, travel and increased antibiotic use during the COVID-19 pandemic. This systematic review and meta-analysis aimed to summarize evidence investigating the global prevalence of ESBL E. coli.Methods Four databases, including Embase, MEDLINE, PubMed and Web of Science, were searched for quantitative studies that reported prevalence data of faecal carriage of ESBL-producing E. coli published between 23 April 2021 and 22 April 2024. Meta-analysis was performed using the inverse variance heterogeneity model.Results Of the 25 studies (13 901 unique participants) included for final analysis, the overall pooled prevalence of ESBL E. coli was 25.4% (95% CI, 19.7%-31.2%). The pooled prevalences of ESBL E. coli in healthy individuals in community settings and inpatients in healthcare settings were 23.4% (95% CI, 14.7%-32.2%) and 27.7% (95% CI, 18.8%-36.7%), respectively. Nearly one-third of the included studies (32%) were from the Western Pacific Region. There was a significant between-group difference for studies with different WHO regions and healthcare contact.Conclusions The pooled prevalence of ESBL E. coli remains high and there was a significant between-group difference for different WHO regions, with the highest being in Asian regions. Standardized surveillance of antimicrobial resistance and antibiotic stewardship especially in these regions are needed to enhance the control of this global emergency.