One Health Perspective of Antibiotic Resistance in Enterobacterales from Southeast Asia: A Systematic Review and Meta-analysis

One Health Perspective of Antibiotic Resistance in Enterobacterales from Southeast Asia: A Systematic Review and Meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article One Health Perspective of Antibiotic Resistance in Enterobacterales from Southeast Asia: A Systematic Review and Meta-analysis Yewei Xie, Isabelle Maya Srivastava, Fengshi Jing, Chenxinan Ma, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7626053/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 18 Dec, 2025 Read the published version in Scientific Reports → Version 1 posted 6 You are reading this latest preprint version Abstract Antimicrobial resistance (AMR) in Enterobacterales poses serious public health, agricultural, and environmental threats. In Southeast Asia, a coordinated “One Health” approach is lacking, and fragmented evidence hampers targeted interventions. This study systematically quantify and analyse AMR prevalence across human, animal, and environmental sectors in Southeast Asia by conducting a meta-analysis of 137 observational studies from 2013 to 2023. We found that Ceftriaxone resistance in E. coli was highest in human samples (49.3%, 95% CI: 37.3–61.3; N = 2,640), followed by environmental (37.1%, 95% CI: 8.4–72.2; N = 288) and animal sources (11.2%, 95% CI: 1.6–27.9; N = 923). In humans, meropenem resistance was 13.0% in K. pneumonia e (95% CI: 2.0–31.3; N = 7,803) and 1.4% in E. coli (95% CI: 0.1–4.4; N = 13,696). Resistance increased over time in human (p = 0.009) and animal sectors (p = 0.004). bla CTX-M and bla TEM were reported across all sectors. This synthesis also highlights a critical evidence gap: most studies focused on Thailand (67) and Vietnam (42). Samples came mostly from animals (62) and humans (59), with limited multi-sector studies. Only one study assessed all four sectors (human, animal, environment, food). Our study reveals an escalating AMR crisis alongside critical research gaps across Southeast Asia. Future efforts must therefore strengthen both integrated surveillance to understand transmission and regional health systems to implement effective One Health action. Health sciences/Diseases Health sciences/Health care Biological sciences/Microbiology Full Text Additional Declarations No competing interests reported. Supplementary Files Supplementaryfileyx0325.xlsx Cite Share Download PDF Status: Published Journal Publication published 18 Dec, 2025 Read the published version in Scientific Reports → Version 1 posted Reviewers agreed at journal 15 Oct, 2025 Reviewers invited by journal 10 Oct, 2025 Editor invited by journal 19 Sep, 2025 Editor assigned by journal 18 Sep, 2025 Submission checks completed at journal 17 Sep, 2025 First submitted to journal 16 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7626053","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":532181130,"identity":"1a460f58-b9b1-4c18-9e33-df2448d530a7","order_by":0,"name":"Yewei Xie","email":"","orcid":"","institution":"Duke-NUS Medical School","correspondingAuthor":false,"prefix":"","firstName":"Yewei","middleName":"","lastName":"Xie","suffix":""},{"id":532181131,"identity":"01cf8267-f9f9-42f4-90b8-d5649d2ea4ff","order_by":1,"name":"Isabelle Maya Srivastava","email":"","orcid":"","institution":"ADVANCE-ID, National University of 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Meta-analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7626053/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7626053/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAntimicrobial resistance (AMR) in Enterobacterales poses serious public health, agricultural, and environmental threats. In Southeast Asia, a coordinated \u0026ldquo;One Health\u0026rdquo; approach is lacking, and fragmented evidence hampers targeted interventions. This study systematically quantify and analyse AMR prevalence across human, animal, and environmental sectors in Southeast Asia by conducting a meta-analysis of 137 observational studies from 2013 to 2023. We found that Ceftriaxone resistance in \u003cem\u003eE. coli\u003c/em\u003e was highest in human samples (49.3%, 95% CI: 37.3\u0026ndash;61.3; N\u0026thinsp;=\u0026thinsp;2,640), followed by environmental (37.1%, 95% CI: 8.4\u0026ndash;72.2; N\u0026thinsp;=\u0026thinsp;288) and animal sources (11.2%, 95% CI: 1.6\u0026ndash;27.9; N\u0026thinsp;=\u0026thinsp;923). In humans, meropenem resistance was 13.0% in \u003cem\u003eK. pneumonia\u003c/em\u003ee (95% CI: 2.0\u0026ndash;31.3; N\u0026thinsp;=\u0026thinsp;7,803) and 1.4% in \u003cem\u003eE. coli\u003c/em\u003e (95% CI: 0.1\u0026ndash;4.4; N\u0026thinsp;=\u0026thinsp;13,696). Resistance increased over time in human (p\u0026thinsp;=\u0026thinsp;0.009) and animal sectors (p\u0026thinsp;=\u0026thinsp;0.004). \u003cem\u003ebla\u003c/em\u003eCTX-M and \u003cem\u003ebla\u003c/em\u003eTEM were reported across all sectors. This synthesis also highlights a critical evidence gap: most studies focused on Thailand (67) and Vietnam (42). Samples came mostly from animals (62) and humans (59), with limited multi-sector studies. Only one study assessed all four sectors (human, animal, environment, food). Our study reveals an escalating AMR crisis alongside critical research gaps across Southeast Asia. Future efforts must therefore strengthen both integrated surveillance to understand transmission and regional health systems to implement effective One Health action.\u003c/p\u003e","manuscriptTitle":"One Health Perspective of Antibiotic Resistance in Enterobacterales from Southeast Asia: A Systematic Review and Meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-24 00:18:12","doi":"10.21203/rs.3.rs-7626053/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"119583334640470418625817077907623351209","date":"2025-10-15T09:28:36+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-10-10T08:20:19+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-09-19T09:20:45+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-18T11:10:17+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-17T05:03:55+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-16T05:14:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"c8a2e6e9-4e55-49c3-aef1-76f6d92c11f5","owner":[],"postedDate":"October 24th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":56568070,"name":"Health sciences/Diseases"},{"id":56568071,"name":"Health sciences/Health care"},{"id":56568072,"name":"Biological sciences/Microbiology"}],"tags":[],"updatedAt":"2025-12-22T16:07:22+00:00","versionOfRecord":{"articleIdentity":"rs-7626053","link":"https://doi.org/10.1038/s41598-025-31195-8","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-12-18 15:58:40","publishedOnDateReadable":"December 18th, 2025"},"versionCreatedAt":"2025-10-24 00:18:12","video":"","vorDoi":"10.1038/s41598-025-31195-8","vorDoiUrl":"https://doi.org/10.1038/s41598-025-31195-8","workflowStages":[]},"version":"v1","identity":"rs-7626053","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7626053","identity":"rs-7626053","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}