Global Distribution of Extended Spectrum Cephalosporin and Carbapenem Resistance and Associated Resistance Markers in Escherichia coli of Swine Origin – A Systematic Review and Meta-Analysis

Shivdeep Singh Hayer, Alejandro Casanova-Higes, Eliana Paladino, Ehud Elnekave, Andre Nault, Tim Johnson, Jeff B Bender, Andres M Perez, Julio Alvarez

Research output: Contribution to journalReview articlepeer-review

12 Scopus citations


Third generation cephalosporins and carbapenems are considered critically important antimicrobials in human medicine. Food animals such as swine can act as reservoirs of antimicrobial resistance (AMR) genes/bacteria resistant to these antimicrobial classes, and potential dissemination of AMR genes or resistant bacteria from pigs to humans is an ongoing public health threat. The objectives of this systematic review and meta-analysis were to: (1) estimate global proportion and animal-level prevalence of swine E. coli phenotypically resistant to third generation cephalosporins (3GCs) and carbapenems at a country level; and (2) measure abundances and global distribution of the genetic mechanisms that confer resistance to these antimicrobial classes in these E. coli isolates. Articles from four databases (CAB Abstracts, PubMed/MEDLINE, PubAg, and Web of Science) were screened to extract relevant data. Overall, proportion of E. coli resistant to 3GCs was lower in Australia, Europe, and North America compared to Asian countries. Globally, <5% of all E. coli were carbapenem-resistant. Fecal carriage rates (animal-level prevalence) were consistently manifold higher as compared to pooled proportion of resistance in E. coli isolates. blaCTX–M were the most common 3GC resistance genes globally, with the exception of North America where blaCMY were the predominant 3GC resistance genes. There was not a single dominant blaCTX–M gene subtype globally and several blaCTX–M subtypes were dominant depending on the continent. A wide variety of carbapenem-resistance genes (blaNDM–, VIM–, IMP–, OXA–48, andKPC–) were identified to be circulating in pig populations globally, albeit at very-low frequencies. However, great statistical heterogeneity and a critical lack of metadata hinders the true estimation of prevalence of phenotypic and genotypic resistance to these antimicrobials. Comparatively frequent occurrence of 3GC resistance and emergence of carbapenem resistance in certain countries underline the urgent need for improved AMR surveillance in swine production systems in these countries.

Original languageEnglish (US)
Article number853810
JournalFrontiers in Microbiology
StatePublished - May 10 2022

Bibliographical note

Funding Information:
This work was funded by the USDA National Institute of Food and Agriculture (Animal Health Formula Fund project MIN-62-091), Swine Disease Eradication Center fund, and the Rapid Agricultural Response Fund (RARF) at the University of Minnesota.

Publisher Copyright:
Copyright © 2022 Hayer, Casanova-Higes, Paladino, Elnekave, Nault, Johnson, Bender, Perez and Alvarez.


  • ESBL
  • Escherichia coli
  • ampC
  • antimicrobial resistance
  • carbapenem
  • cephalosporin
  • pigs
  • systematic review

PubMed: MeSH publication types

  • Journal Article
  • Review


Dive into the research topics of 'Global Distribution of Extended Spectrum Cephalosporin and Carbapenem Resistance and Associated Resistance Markers in Escherichia coli of Swine Origin – A Systematic Review and Meta-Analysis'. Together they form a unique fingerprint.

Cite this