Carbapenem resistant Enterobacteriaceae in the livestock, humans and environmental samples around the globe: A systematic review and meta-analysis

Abstract Introduction and objectives: Carbapenem-resistant Enterobacteriaceae (CRE) have diminished treatment options causing serious morbidities and mortalities. This systematic review and meta-analysis assessed the prevalence and associated factors of Enterobacteriaceae infections in clinical, livestock and environmental settings globally. Data sources: The population intervention comparison and outcome (PICO) strategy was used to enroll studies using the Preferred Reporting System for Systematic Review and Meta-analysis (PRISMA) to include only cross-sectional studies. Search engines included journal author name estimator (JANE), PubMed, Google scholar, African Journals Online (AJOL), World cat, Green version, CrossRef and snow balling of retrieved articles. The Newcastle-Ottawa Scale (NOS) was used to assess the quality of studies. Results Sixteen articles from 2013 to 2023 in Africa, Asia, Europe and South America were studied. The pooled prevalence of CRE was 43.06% (95% CI, 21.57 to 66.03). Klebsiella pneumoniae (49.40%), Escherichia coli (26.42%), and Enterobacter cloacae (14.24%) were predominat. Klebsiella pneumoniae had the highest resistance with the blaKPC-2 in addition to blaNDM, blaOXA-48, blaIM and blaVIM. The blaKPC-2 genes occurence were associated with environmental (p. Value < 0.0001) and South American studies (p. Value < 0.0001), but there was no difference in the trends over time (p. Value = 0.745). Conclusion This study highlights the high rates of CRE infections, particularly within Klebsiella pneumoniae, especially the blaKPC production. Monitoring and surveillance programs, research and infection control measures should consider be strengthened. Additionally, further studies are needed to explore the mechanisms driving the predominance of specific bacterial species and the distribution of resistance genes within this bacterial family.