Circulation of extended-spectrum β-lactamase and plasmid-borne cephalosporinase-producing Escherichia coli from a One Health perspective: a narrative review

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BACKGROUND: The global rise of extended-spectrum β-lactamase (ESBL) and plasmid-borne cephalosporinase (pAmpC) producing Enterobacterales is a major health concern. Their increasing prevalence in both humans and animals underscores the need for One Health surveillance, for which Escherichia coli has been recognized as a key indicator. While many studies have investigated the circulation of ESBL/pAmpC-producing E. coli (ESBL/pAmpC-Ec) across human, animal, and environmental sectors, the extent to which animals contribute to human acquisition remains unclear. OBJECTIVES: This review provides an overview of the intersectoral circulation of ESBL/pAmpC-Ec and evaluates the potential role of animals as a reservoir for human colonization. SOURCES: Publications (2010-2024) identified through PubMed, Scopus, and Google Scholar, on ESBL/pAmpC-Ec circulation across human, animal, and environmental sectors (excluding studies on human-environment, animal-environment, and human-food only) were reviewed considering the included sectors, comparison methods, and geographical context. CONTENT: Surveillance approaches varied widely between studies, shaped by sampling strategies, geographical context, and isolated comparison methods. Advances in genomic methods have refined our understanding of ESBL/pAmpC-Ec circulation between sectors. Early studies, mostly conducted in high-income countries (HICs), suggested human-animal transmission based on comparisons of ESBL/pAmpC-Ec sequence types, resistance genes, and plasmid replicons. However, these findings were challenged by the introduction of more discriminating comparison methods such as whole-genome sequencing, which revealed a largely compartmentalized circulation of ESBL/pAmpC-Ec in HICs. Similar studies in low- and middle-income countries (LMICs) shifted this paradigm, demonstrating frequent cross-sectoral transmission across humans, animals, and the environment. Many authors also highlighted the likely underestimated role of plasmids in the circulation of ESBL/pAmpC genes. IMPLICATIONS: Despite the heterogeneity of the studies, two distinct scenarios emerged: predominantly intrasectoral ESBL/pAmpC-Ec circulation in HICs and significant intersectoral circulation in LMICs. These findings underscore the need for region-specific antimicrobial resistance control strategies, focusing on limiting human-to-human transmission in HICs and enhancing sanitation and biosecurity in LMICs.