Antimicrobial resistance in Ecuador, 2000-2024: a systematic review within a One Health framework

Area of Science:

• Public Health
• Microbiology
• Epidemiology

Background:

• Antimicrobial resistance (AMR) poses a significant global health threat, especially in low- and middle-income countries.
• AMR research in Ecuador has increased but remains fragmented, primarily focusing on the human health sector.

Purpose of the Study:

• To systematically review laboratory-confirmed bacterial resistance in Ecuador from 2000-2024 across human, animal, food, and environmental sources.
• To identify research gaps and inform public health policy and AMR prevention strategies.

Main Methods:

• Systematic literature review of studies reporting bacterial resistance in Ecuador.
• Inclusion criteria: laboratory-confirmed resistance, 2000-2024, human, animal, food, or environmental sources.
• Data extraction focused on bacterial species, resistance patterns, geographic distribution, and study settings.

Main Results:

• Eighty studies were included, predominantly hospital-based and urban.
• Gram-negative bacteria (e.g., Escherichia coli, Klebsiella pneumoniae, Salmonella spp.) showed the highest resistance burden.
• Notable resistance to beta-lactams, fluoroquinolones, and carbapenems (among WHO priority pathogens) was observed.
• Evidence from non-human sectors was scarce and molecular data was inconsistently reported.

Conclusions:

• Significant surveillance gaps exist beyond hospital settings in Ecuador.
• Integrated, multisectoral surveillance is crucial for effective antimicrobial stewardship and AMR prevention.
• Findings highlight the need for expanded research in rural, Amazonian, and insular regions.