Global antibiotic resistance trends in Enterococcus faecalis from animals, food, and environmental sources: A meta-analysis.

This systematic review investigates the prevalence of antibacterial resistance in Enterococcus faecalis outside clinical settings, focusing on animals, food, and the environment. Using a "One Health" approach connecting human, animal, and environmental health, we analyze resistance patterns across diverse geographical regions and timeframes, emphasizing the impact of geographical factors. We thoroughly searched various databases, including Scopus, PubMed, Web of Science, and EMBASE. We assessed study quality using the Newcastle-Ottawa Scale Checklist. A random-effects model estimated resistance proportions, while meta-regression, subgroup analyses, and identification of outliers and influential studies provided additional insights. We employed R software (version 4.2.1) and the metaphor package (version 3.8.1) for comprehensive data management and analysis. Our analysis of 75 studies revealed significant variability in antibiotic resistance across countries, continents, and World Health Organization (WHO) regions in non-clinical E. faecalis. Resistance rates differed based on antibacterial agents, geographic regions, periods, and isolation sources. Resistance was highest to tetracycline, rifampicin, quinupristin-dalfopristin, doxycycline, and erythromycin (≈48-62 %). Moderate resistance was observed for streptomycin, kanamycin, ciprofloxacin, gentamicin, chloramphenicol, and linezolid (≈10-26 %). In contrast, low resistance rates (<10 %) were found for vancomycin, teicoplanin, levofloxacin, nitrofurantoin, and fosfomycin. Considerable heterogeneity was noted across most antibiotics. This review emphasizes the influence of geographic variations and isolated sources on E. faecalis resistance patterns. We underscore the urgent need for a collaborative One Health approach, integrating human, animal, and environmental health sectors, to tackle antibacterial resistance in E. faecalis effectively.