Prevalence and Antimicrobial Resistance Profiles of Enterococci Isolated From Humans, Animals, and Environment in Bangladesh: A Systematic Review and Meta-Analysis.

BACKGROUND

Enterococci are important opportunistic pathogens responsible for a wide range of infections in humans and animals. Their ability to acquire and disseminate antimicrobial resistance (AMR) poses a growing public health concern. This study is aimed at estimating the pooled prevalence of enterococci and their AMR profiles among isolates from humans, animals, and environmental sources in Bangladesh.

METHODS

We conducted a systematic literature search in PubMed, Google Scholar, and CAB Abstracts in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published between January 2016 and November 2025 that reported the prevalence and/or AMR patterns of enterococci in Bangladesh were eligible for inclusion. A total of 36 studies met the inclusion criteria and were included in the final analysis. Pooled prevalence estimates were calculated using random-effects meta-analysis, with heterogeneity assessed via Cochran's Q and the I 2 statistic; AMR proportions were estimated using the Wilson method, and publication bias was evaluated using Egger's test and funnel plots.

RESULTS

The pooled prevalence of enterococci was estimated at 12.05% (95% CI: 7.10-19.70), with substantial heterogeneity (I 2 = 99.4%). Among eight identified Enterococcus spp., Enterococcus faecalis was the most prevalent (25.1%; 95% CI: 20.9-29.2), followed by Enterococcus faecium (6.3%; 95% CI: 4.6-7.9). High resistance rates were observed against cefuroxime (77.1%) and ceftriaxone (73.4%), whereas resistance to vancomycin was 20.9%.

CONCLUSIONS

The findings underscore the urgent need for rational antimicrobial use, strengthened infection prevention and control measures, improved environmental hygiene, and integrated One Health surveillance across human, animal, and environmental settings to mitigate the burden of antimicrobial-resistant enterococci.