Occurrence and molecular characteristics of carbapenem-resistant Enterobacteriaceae recovered from wildlife: a systematic review and meta-analysis
- 1College of Veterinary Medicine and Bio-Safety Research Institute, Jeonbuk National University
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) represent a critical concern in the antimicrobial resistance (AMR) landscape due to their resistance to critical last-line antibiotics and their capacity for horizontal gene transfer. Although CRE are well described in clinical and livestock settings, evidence from wildlife remains scattered, limiting understanding of their ecological distribution outside managed systems. We conducted a systematic review and meta-analysis following PRISMA guidelines, screening 6,988 records published between January 2000 and July 2025 across three databases (PubMed, Scopus, and Web of Science), and 19 studies met the inclusion criteria. Using a random-effects model, the pooled CRE-positive proportion among recovered Enterobacteriaceae isolates tested for carbapenem resistance was estimated at 74.49% (95% CI: 49.75%–94.04%), with substantial between-study heterogeneity ( I ² = 96%). However, this isolate-level estimate should not be interpreted as the prevalence of CRE carriage among wild animals. Species-level stratification revealed CRE-positive proportions of 76.51% for Escherichia coli , 72.41% for Klebsiella spp., and 86.46% for other Enterobacteriaceae genera, including Citrobacter and Enterobacter spp.; however, these subgroup estimates should be interpreted cautiously, as confidence intervals were wide and heterogeneity remained substantial across several analyses. The highest descriptive estimate was observed in water-associated environments (84.49%), while differences among sampling environments were not statistically significant. Although pooled estimates varied descriptively across host taxonomic order, carbapenem agent, continent, and phenotypic susceptibility testing method, only sample type showed a statistically significant subgroup difference ( p < 0.01), while univariate meta-regression explained limited between-study variability overall. Clinically important carbapenemase-encoding genes, including bla NDM, bla KPC, bla OXA-48-like, bla VIM, and bla IMP, and diverse sequence types were reported across continents. Given the highly restricted veterinary use of carbapenems, these findings are consistent with potential exposure to resistant bacteria or resistance determinants originating from anthropogenically influenced environments; however, transmission direction cannot be established from the available evidence. Overall, wildlife may serve as useful sentinels of environmental CRE contamination, while longitudinal surveillance and genomic transmission studies are needed to clarify their role in CRE persistence and dissemination.
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BibTeX
@article{yim2026occurrence,
title = {{Occurrence and molecular characteristics of carbapenem-resistant Enterobacteriaceae recovered from wildlife: a systematic review and meta-analysis}},
author = {Ji-hwan Yim and Maryum Tanveer and Eurade Ntakiyisumba and Jin Hur and Gayeon Won},
journal = {Frontiers in Microbiology},
year = {2026},
month = oct,
doi = {10.3389/fmicb.2026.1897815},
url = {https://www.frontiersin.org/articles/10.3389/fmicb.2026.1897815/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Occurrence and molecular characteristics of carbapenem-resistant Enterobacteriaceae recovered from wildlife: a systematic review and meta-analysis
AU - Ji-hwan Yim
AU - Maryum Tanveer
AU - Eurade Ntakiyisumba
AU - Jin Hur
AU - Gayeon Won
PY - 2026
DA - 2026/10/16
JO - Frontiers in Microbiology
DO - 10.3389/fmicb.2026.1897815
UR - https://www.frontiersin.org/articles/10.3389/fmicb.2026.1897815/full
AB - Carbapenem-resistant Enterobacteriaceae (CRE) represent a critical concern in the antimicrobial resistance (AMR) landscape due to their resistance to critical last-line antibiotics and their capacity for horizontal gene transfer. Although CRE are well described in clinical and livestock settings, evidence from wildlife remains scattered, limiting understanding of their ecological distribution outside managed systems. We conducted a systematic review and meta-analysis following PRISMA guidelines, screening 6,988 records published between January 2000 and July 2025 across three databases (PubMed, Scopus, and Web of Science), and 19 studies met the inclusion criteria. Using a random-effects model, the pooled CRE-positive proportion among recovered Enterobacteriaceae isolates tested for carbapenem resistance was estimated at 74.49% (95% CI: 49.75%–94.04%), with substantial between-study heterogeneity ( I ² = 96%). However, this isolate-level estimate should not be interpreted as the prevalence of CRE carriage among wild animals. Species-level stratification revealed CRE-positive proportions of 76.51% for Escherichia coli , 72.41% for Klebsiella spp., and 86.46% for other Enterobacteriaceae genera, including Citrobacter and Enterobacter spp.; however, these subgroup estimates should be interpreted cautiously, as confidence intervals were wide and heterogeneity remained substantial across several analyses. The highest descriptive estimate was observed in water-associated environments (84.49%), while differences among sampling environments were not statistically significant. Although pooled estimates varied descriptively across host taxonomic order, carbapenem agent, continent, and phenotypic susceptibility testing method, only sample type showed a statistically significant subgroup difference ( p < 0.01), while univariate meta-regression explained limited between-study variability overall. Clinically important carbapenemase-encoding genes, including bla NDM, bla KPC, bla OXA-48-like, bla VIM, and bla IMP, and diverse sequence types were reported across continents. Given the highly restricted veterinary use of carbapenems, these findings are consistent with potential exposure to resistant bacteria or resistance determinants originating from anthropogenically influenced environments; however, transmission direction cannot be established from the available evidence. Overall, wildlife may serve as useful sentinels of environmental CRE contamination, while longitudinal surveillance and genomic transmission studies are needed to clarify their role in CRE persistence and dissemination.
SN - 1664-302X
ER -