Prevalence of extended-spectrum β-lactamase and carbapenemase-producing Escherichia coli from patients, cattle, and environmental sources in northwest Amhara, Ethiopia: a one health approach

Abstract

BACKGROUND: Escherichia coli (E. coli) is a Gram-negative, ubiquitous bacterium found in humans, animals, and the environment. Certain strains, notably extended-spectrum β-lactamase-producing E. coli (ESBL-PEC) and carbapenemase-producing E. coli (CPEC), cause life-threatening intestinal and extraintestinal infections. While some studies exist in patients, data on the prevalence of ESBL-PEC and CPEC among human patients, cattle, and the environment, using a One Health approach, are limited. We aimed to determine the prevalence of ESBL-PEC and CPEC among patients, cattle, and the environment in northwest Amhara, Ethiopia, using a One Health approach. METHODS: A cross-sectional study was conducted from January to August 2025 among 972 study participants, including human patients (508), animals (158), and environmental samples (306). Consecutive sampling was used to select patients and animals. Purposive sampling was used to select environmental samples. Urine or blood from patients, recto-anal mucosal swab from animals, swab, and wastewater from the environment were collected and processed for E. coli isolation using standard microbiological methods. ESBL-PEC and CPEC were identified using a combination disk diffusion test and a modified carbapenem inactivation method, respectively, in accordance with the Clinical Laboratory Standard Institute guidelines. Associations were assessed using Chi-square in SPSS, and antimicrobial resistance (AMR) profiles of E. coli isolates using a heatmap in R software. RESULTS: The prevalence of ESBL-PEC among E. coli isolated from patients was 52.4% (33/63, 95% CI: 40.3-64.2), while 33.3% (24/72, 95% CI: 23.5-44.8) among environmental isolates and 6.6% (10/151, 95% CI: 3.6-11.8) among cattle isolates. The prevalence of CPEC among patient isolates was 9.5% (6/63, 95% CI: 4.4-19.3) and 2.8% (2/72, 95% CI: 0.8-9.6) in environmental isolates, while no CPEC was detected among cattle isolates. All ESBL-PEC and CPEC isolates were multidrug resistant (MDR). Among non-β-lactam antibiotics tested, ESBL-PEC and/or CPEC isolates showed the highest co-resistance to ciprofloxacin (81.3%), followed by gentamicin (56%), while the lowest was for amikacin (17.3%). Overall, 90.5% (57/63) of E. coli from patients, and 81.9% (59/72) from environmental sources, and 29.1% (44/151) from cattle were MDR. CONCLUSIONS: The prevalence of ESBL-PEC and CPEC was high in patients and the hospital environment, whereas ESBL-PEC was low in cattle. No CPEC was detected in cattle. Widespread MDR E. coli presence in patients, the environment, and cattle underscores the need for reinforced infection prevention and control measures in hospitals and AMR surveillance based on a One Health approach.