Global prevalence of tigecycline-resistant foodborne Enterobacterales along the food chain: A meta-analysis

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.