Antimicrobial resistance and ESBL production in uropathogenic Escherichia coli: a systematic review and meta-analysis in Ethiopia

Abstract Background Antimicrobial resistance (AMR) is a serious threat to global health systems. Escherichia coli is a major cause of urinary tract infections (UTIs). Understanding the AMR patterns of uropathogenic E. coli (UPEC) is crucial for effective public health interventions worldwide. Objectives This systematic review and meta-analysis aimed to consolidate existing research and provide a comprehensive information on AMR UPEC in Ethiopia. Methods We systematically searched databases such as PubMed, Web of Science, and Science Direct, along with including articles from Google Scholar. Data were extracted into Microsoft Excel and analysed using STATA 17.0. Cohen’s kappa was computed to assess reviewer agreement, while the I2 statistic evaluated heterogeneity. Egger’s tests were conducted to detect publication bias, and random-effects models were utilized to estimate the pooled resistance, with AMR rates for each antibiotic pooled separately. Results UPEC showed resistance rates, ranging from 3.64% (95% CI: −4.38% to 11.67%) for amikacin to 85.32% (95% CI: 78.6%–92.04%) for ampicillin. Highest resistance was to ampicillin (85.32%), followed by amoxicillin at 82.52% (95% CI: 74.3%–90.74%), tetracycline at 60.67% (95% CI: 51.53%–69.81%) and trimethoprim/sulfamethoxazole at 57.17% (95% CI: 49.93%–64.42%). Conversely, resistance rates were lower for amikacin at 3.64% and meropenem at 5.26% (95% CI: 2.64%–7.88%). UPEC demonstrated a pooled MDR rate of 79.17% (95% CI: 70.32%–88.01%) and a pooled ESBL production rate of 29.16% (95% CI: 22.36%–38.55%). Conclusions High levels of AMR were observed in UPEC strains, highlighting a critical public health issue requiring urgent action through robust antimicrobial stewardship and surveillance to preserve effective UTI treatment options.