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E. coli isolates in Iran show 71.7% resistance to penicillins and 47.2% ESBL productionRising Antibiotic Resistance in E. coli Bacteria Found in Iran

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Key Takeaway
Note high penicillin resistance (71.7%) and ESBL production (47.2%) in Iranian E. coli isolates.

This meta-analysis synthesizes data from 368 studies to evaluate the prevalence of antimicrobial resistance and resistance genes in E. coli isolates from human, animal, food, and environmental sources in Iran. The scope of the review covers both phenotypic resistance and the presence of specific resistance genes.

Key findings include a high prevalence of resistance to penicillins at 71.7% (95% CI: 65.6-76.6) and a lower prevalence of resistance to fosfomycins at 6.8% (95% CI: 5.2-8.5). The analysis also identified 47.2% ESBL-producing isolates, 20.2% AmpC-producing isolates, and 14.1% MBL-producing isolates. Resistance to ceftizoxime, ertapenem, streptomycin, piperacillin-tazobactam, and colistin was reported to increase over time.

While the study provides a comprehensive overview of the regional landscape of resistance genes, specific limitations were not reported. The findings emphasize the critical need for robust antimicrobial stewardship within a One Health framework to preserve the efficacy of existing antibiotics. The data serves as a baseline for policy-making regarding local resistance trends.

How this fits prior evidence

This meta-analysis addresses a gap in regional surveillance of E. coli resistance. It complements the finding that beta-lactam/beta-lactamase inhibitor therapy reduces all-cause mortality in multidrug-resistant Gram-negative infections by highlighting the high prevalence of ESBL (47.2%) and MBL (14.1%) producing isolates in the Iranian region. It also provides context for the importance of stewardship, which is relevant given that antibiotic exposure can disrupt gut microbiota in 58% to 94% of critically ill children.

A large review of 368 studies analyzed E. coli bacteria found in humans, animals, food, and the environment in Iran. The study looked at how well these bacteria resist common antibiotics and the specific genes that allow them to survive treatment.

The findings show a high level of resistance to Penicillins, which was reported at 71.7 percent. In contrast, resistance to Fosfomycin was much lower at 6.8 percent. The review also noted that resistance to several other antibiotics, including Ceftizoxime, Ertapenem, Streptomycin, Piperacillin-Tazobactam, and Colistin, has increased over time.

These results highlight a growing concern regarding how effectively current medicines can treat infections. Because the data comes from a broad review of existing studies rather than a single clinical trial, it serves as a baseline for policy making. It emphasizes the need for better management of antibiotics to ensure they remain effective for patients in the future.

What this means for you:
E. coli shows high resistance to Penicillins and increasing resistance to several other common antibiotics.

Common questions

Which antibiotics showed the highest resistance?

The study found that Penicillins had the highest level of resistance among the antibiotics tested, with a reported rate of 71.7 percent. This indicates that many E. coli isolates are no longer affected by this specific class of medication.

Which antibiotic showed the lowest resistance?

Fosfomycin showed the lowest level of resistance in the study, with a reported rate of 6.8 percent. This suggests it remains more effective against the sampled E. coli than many other options.

Are some antibiotics becoming less effective over time?

Yes, the data shows that resistance to Ceftizoxime, Ertapenem, Streptomycin, Piperacillin-Tazobactam, and Colistin has increased over time. This trend highlights the growing challenge of antibiotic resistance in the environment.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedOct 2026
View Original Abstract ↓
Escherichia coli (E. coli) has developed resistance to multiple antibiotic classes, complicating treatment in both human and veterinary medicine. This study assesses the prevalence of antimicrobial resistance and antimicrobial resistance genes in E. coli in Iran, within a One Health framework encompassing humans, animals, foods, and the environment. We systematically searched Scopus, Google Scholar, Magiran, PubMed, Scientific Information Database Library (SID), and Web of Science, using keywords related to AMR and Escherichia coli, restricting to English and Persian publications from 2010 to January 2025. The risk of bias was evaluated using the JBI checklist for prevalence studies. Pooled prevalence and 95% confidence intervals (CIs) were calculated for each antibiotic using random-effects models. A total of 368 studies were included in the meta-analysis. The highest resistance was observed in the Classes of Penicillins (71.7, 95% CI: 65.6-76.6) and the lowest for Fosfomycins (6.8, 95% CI: 5.2-8.5). Resistance to Ceftizoxime, Ertapenem, Streptomycin, Piperacillin-Tazobactam, and Colistin increased over time. Phenotypically, 47.2%, 20.2%, and 14.1% of E. coli isolates were identified as extended-spectrum β-lactamase-producing (ESBL), AmpC, and metallo-beta-lactamase (MBL) producing, respectively. Among ESBL-producing isolates, the prevalence of bla, bla, and bla genes was 68.2%, 58.5%, and 24.4%, respectively. The high prevalence of AMR highlights the critical need for robust antimicrobial stewardship within a One Health framework to preserve antibiotic efficacy. Our study provides essential baseline data across human, animal, and environmental sectors in Iran, forming a basis for future One Health strategies and policy-making.
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