One Health distribution of beta-lactamases in Enterobacterales in the United States: A systematic review and meta-analysis.

Background: The study aimed to review the beta-lactamase resistance genes detected in Enterobacterales from humans, animals, and the environment in the United States.

Methods: We conducted a comprehensive search on PubMed, Web of Science, and Google Scholar for articles reporting beta-lactamase genes in the United States from 1981 to 22 April 2022, following the PRISMA protocol. Studies were evaluated based on predefined eligibility criteria, and both qualitative and quantitative analyses were conducted on the selected studies.

Results: Of the 335 articles, a total of 169 different beta-lactamase genes, including narrow-spectrum, extended-spectrum, AmpC, and carbapenemase have been detected and reported in the United States, with human (137), animal (53), and environment (47). 22 genes (bla_CMY-2, bla_{CTX-M-(1, 2, 9, 14, 15, 27, 32, 65)}, bla_FOX-5, bla_IMP-27, bla_KPC-2, bla_{NDM-(1, 5)}, bla_{OXA-(1, 48)}, bla_PSE-1, bla_{SHV-(1, 12)}, bla_{TEM-(1, 1A, 1B)}) have been reported across animals, humans, and environment. Notably, bla_CTX-M-15 was prevalent in E. coli isolates, with an overall pooled proportion of 10.7 %, varying between animals (8.6 %), humans (13.1 %), and the environment (0.8 %). Similarly, bla_CMY-2 in E. coli isolates had an overall pooled proportion of 10.6 %, with distinctions in proportion among animals (1.6 %), humans (41.3 %), and the environment (16.2 %). The sequence type (ST131) was detected as the predominant, mainly associated with the bla_CTX-M-15, with a pooled proportion of 56.9 %, varying from 14.3 % to 90 % across studies.

Conclusion: This study highlights the distribution of beta-lactamases in the United States, essential for understanding One Health and the molecular epidemiology of key beta-lactamases, especially extended-spectrum beta-lactamases and carbapenemases.