Carbapenem-resistant E. coli with one-health approach in East Africa: Systematic review and meta-analysis

Objective Carbapenem-resistant E. coli is one of the most serious and urgent global health threats. This study aimed to explore the occurrence and characteristics of carbapenem-resistant E. coli in East African countries using a one-health approach. Study Design A systematic review and meta-analysis study. Methods This review was done based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines. The protocol of this study was also registered on the International Prospective Register of Systematic Reviews (PROSPERO) database (Registration Identification: CRD42024626968). Results The pooled prevalence of carbapenem-resistant E. coli in East Africa among different interfaces like human, animal, environment, and food was 12.7% (95% CI: 8.6, 16.8). The environment exhibited the predominant interface for carbapenem-resistant E. coli (24.2%), followed by human (11.9%), food (7.7%) and animals (4.2%). The carbapenem-resistant E. coli prevalence decreased in 2021 - 2025 (12.6%) as compared to 2015-2020 (13.5%). High prevalence was seen in Sudan (24.7%), Uganda (17.4%), and Ethiopia (9.9%) and predominantly found in environmental samples (24.2%) and various clinical samples (15.8%). Different resistance gene variants, including serine β-lactamases, metallo-β-lactamases, and oxacillinase, were found in 51.7% of the studies. Conclusions Carbapenem-resistant E. coli is prevalent and poses a potential future threat in East African countries. It needs multifaceted strategies, including regional integration beyond health policy to mitigate the problem.