Prevalence of carbapenem-resistant E. coli and Klebsiella spp: a systematic review and meta-analysis of non-clinical isolates from Nigeria.

The issue of bacterial resistance remains a significant public health problem, with carbapenem-resistant Klebsiella spp and E. coli having adverse effects on agriculture and healthcare. Nonetheless, the true prevalence of CRE in non-clinical settings in Nigeria is unknown. Thus, for the first time, this study undertook a systematic review and meta-analysis to offer comprehensive data on the prevalence of carbapenem-resistant E. coli and Klebsiella spp in non-clinical isolates from Nigeria. The guideline of the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) was followed. Multiple databases were searched for relevant studies and data from eligible studies were analyzed using the random effect model. From 321 retrieved records, 17 were included. The pooled prevalence of carbapenem-resistant E. coli was 14.2% (95% CI: 4.6-36.0, I² = 94.51, p < 0.001), which was lower than carbapenem-resistant Klebsiella spp at 37.8% (95% CI: 13.6-70.2, I² = 86.48, p < 0.001). The prevalence of E. coli and Klebsiella spp was highest in Nasarawa and Ebonyi, with estimates of 85.0% (95% CI: 70.4% - 93.1%) and 80.1% (95% CI: 69.8-87.5%), respectively. The prevalence of Klebsiella spp. was greater in the South-East region (63.0%) compared with the South-West region (4.5%) of the country. There was a significant variation in the prevalence of these pathogens depending on the sample sources, with a progressive increase observed over time. This study underscores a notable prevalence of carbapenem-resistant pathogens in non-clinical settings, highlighting the imperative for a holistic management approach.