Insight into the Prevalence of Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae in Vegetables: A Systematic Review and Meta-Analysis.

The occurrence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in vegetables is an escalating global problem. This study aimed to document the global prevalence of ESBL-producing Enterobacteriaceae in vegetables using a comprehensive meta-analysis. A web-based search of electronic databases such as ScienceDirect, Google Scholar, and PubMed was conducted using studies published between 2014 and 2024. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines were followed for the systematic review and meta-analysis. The Comprehensive Meta-Analysis (CMA) Ver 4.0 software was used to analyse the data. The pooled prevalence estimate (PPE) with a 95% confidence interval (CI) was calculated using the random effects model. After reviewing 1802 articles, 63 studies were carefully analyzed and were part of the comprehensive meta-analysis. The overall PPE of ESBL-producing Enterobacteriaceae (ESBL-E) was 11.9% (95% CI: 0.091-0.155), with high heterogeneity (I = 96.8%, < 0.001) from 2762 isolates. The ESBL-encoding gene was the most prevalent, showing a PPE of 42.8% (95% CI: 0.269-0.603), while the PPE of -beta-lactamase-producing Enterobacteriaceae was 4.3% (95% CI: 0.025-0.71). Spain had a high ESBL-E PPE of 28.4% (0.284; 95% CI: 0.057-0.723, I = 98.2%), while China had the lowest PPE at 6.4% (0.064; 95% CI: 0.013-0.259, I = 95.6%). Continentally, the PPE of ESBL-E was significantly higher in reports from South America at 19.4% (95% CI: 0.043-0.560). This meta-analysis showed that ESBL-E in vegetables increased by 9.0%, 9.8%, and 15.9% in 2018-2019, 2020-2021, and 2022-2024, respectively. The findings emphasize the potential risks of consuming raw or inadequately cleaned produce and the importance of vegetables as ESBL-E reservoirs. Our work calls for immediate attention to food safety procedures and more thorough surveillance as antibiotic resistance rises to reduce antimicrobial resistance risks in food systems.