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Tigecycline-resistant Enterobacterales prevalence in the global food chain is 4.36% with high tet(X4) carriageTigecycline Resistance Found in Global Food Chain and Farm Products

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Key Takeaway
Note the 4.36% tigecycline resistance rate in Enterobacterales and high tet(X4) carriage in the global food chain.

This meta-analysis synthesized data from 104 studies and 130 reports to evaluate the prevalence of tigecycline resistance and tet(X4) carriage in Enterobacterales within the global food chain, including farms, retail markets, and produce. The analysis identified an overall tigecycline resistance rate of 4.36% (95% CI: 2.83%-6.20%). Among the resistant strains, the prevalence of the tet(X4) gene was 73.81% (95% CI: 43.79%-94.96%).

Geographic and site-specific data revealed varying resistance rates: 5.05% at farms, 2.61% at retail markets, and 3.82% in fruits and vegetables. Regionally, the resistance rate in Asia was 5.30%, which was higher than the 2.68% observed in Europe. Furthermore, E. coli accounted for 93.01% of the resistant strains identified.

The authors suggest that farms and the Asian region are critical points for monitoring. The presence of resistance in fruits and vegetables warrants clinical vigilance. The findings suggest a need for stronger veterinary tetracycline regulation and enhanced monitoring of tigecycline resistance to manage risks associated with carbapenem-resistant Enterobacterales.

How this fits prior evidence

This meta-analysis addresses a gap in understanding the environmental prevalence of tigecycline resistance in Enterobacterales. It complements the existing review of therapeutic options for carbapenem-resistant Enterobacterales by providing specific data on the prevalence of the tet(X4) gene in the food chain. It also relates to the evidence for tigecycline as a potential option for polymicrobial infections involving carbapenem-resistant organisms by highlighting the widespread presence of tigecycline resistance in the environment.

A large-scale review of 104 studies analyzed the presence of tigecycline-resistant bacteria in the global food chain. This included samples from farms, retail markets, and fruits and vegetables. The study focused on Enterobacterales, which are bacteria that can cause infections.

The findings showed a global tigecycline resistance rate of 4.36 percent. Among the resistant strains, 93.01 percent were E. coli. The study also found that 73.81 percent of these resistant strains carried the tet(X4) gene. Resistance rates varied by location: 5.05 percent at farms, 2.61 percent at retail markets, and 3.82 percent in fruits and vegetables.

Geographic differences were noted, with a 5.30 percent resistance rate in Asia compared to 2.68 percent in Europe. Because these bacteria are found in various stages of the food supply, experts suggest that farms and regions like Asia are key points for monitoring. These results highlight the need for better regulation of certain antibiotics in animals to manage resistance in the food chain.

What this means for you:
Tigecycline-resistant bacteria were found across various stages of the global food supply chain.

Common questions

Where was tigecycline resistance found in the food chain?

The study found tigecycline resistance in several areas of the food chain. Specifically, the resistance rate was 5.05 percent at farms, 2.61 percent at retail markets, and 3.82 percent in fruits and vegetables.

Was there a difference in resistance rates between regions?

Yes, the study found different rates based on location. The resistance rate in Asia was 5.30 percent, which was higher than the 2.68 percent found in Europe.

What types of bacteria were involved in this study?

The study looked at Enterobacterales. Among the strains that showed resistance to tigecycline, 93.01 percent were identified as E. coli.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedNov 2026
View Original Abstract ↓
Tigecycline is a last-resort antibiotic for treating infections caused by carbapenem-resistant Enterobacterales (CRE). The emergence and dissemination of tigecycline-resistant Enterobacterales through the food chain pose a growing public health concern. This study systematically evaluates the global prevalence of tigecycline-resistant Enterobacterales and the tet(X4) carriage rate in foods and food-producing animals, and analyzes the epidemiological characteristics across supply chain stages, bacterial genera, regions, and sample types. We searched PubMed, Scopus, Web of Science, Engineering Index (EI), and China National Knowledge Infrastructure (CNKI) for studies published from January 2015 to December 2025. A random-effects model pooled resistance rates, and subgroup analyses explored heterogeneity. A total of 104 studies (130 reports) were included. The overall resistance rate was 4.36% (95% CI: 2.83%-6.20%); among resistant strains, tet(X4) prevalence (13 reports) was 73.81% (95% CI: 43.79%-94.96%). E.coli accounted for 93.01% of resistant strains. The highest resistance rate was at farms (5.05%), followed by retail markets (2.61%) and fruits and vegetables (3.82%). Asia showed a significantly higher rate (5.30%) than Europe (2.68%). Although overall prevalence is low, tet(X4) is highly prevalent among resistant strains, with E. coli as the predominant host. Farms and Asia are key control points, and resistance in fruits and vegetables warrants vigilance. Strengthening veterinary tetracycline regulation and incorporating tigecycline resistance monitoring into routine food chain surveillance are strongly recommended.
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