Prevalence of ESBL-producing Escherichia coli in sub-Saharan Africa: A meta-analysis using a One Health approach

The rise in the prevalence of antimicrobial-resistant (AMR) pathogens globally has been a major concern, especially due to the increasing mortality associated with AMR. One of these pathogens -classified as a WHO priority pathogen- is extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. In this study, we aim to determine the prevalence of ESBL-producing E. coli in sub-Saharan Africa (SSA) as well as the genes responsible for its spread in the region. Based on the PRISMA guideline, we screened 6521 articles published between 2013 and 2023 from PubMed, AJOL, Google Scholar, Scopus, and Web of Science using pre-set eligibility criteria. The final meta-analysis included one hundred and ninety-six of these articles. In this study, we reported an overall ESBL-producing E. coli prevalence of 20.76 % in SSA. Subregion analysis showed that West Africa had the highest prevalence of 22.80 % while Southern Africa (13.76 %) has the lowest ESBL-producing E. coli prevalence in SSA. Among the countries in SSA, Burkina Faso (33.37 %) had the highest prevalence of ESBL-producing E. coli. Additionally, sample source subgroup analysis revealed animals as the highest source of ESBL-producing E. coli in SSA with a prevalence of 29.15 %. We also found that bla _CTX-M-15 is the most reported ESBL gene in E. coli in SSA. Our study shows a high prevalence of ESBL-producing E. coli in SSA countries, with animals significantly contributing to the spread of ESBL resistance in the region compared to humans, the environment and food. This study further emphasizes the importance of an interdisciplinary and intergovernmental approach to reducing AMR spread in SSA. Additionally, we implore policymakers to implement policies that will encourage responsible use of antimicrobials in both the clinic and agriculture to prevent the widespread of AMR genes.