Global distribution and incidence of multidrug resistant and ESBL producing Escherichia coli: an observational study of the ATLAS dataset

<h2>Abstract</h2><h3>Objective</h3> The emergence and spread of AMR pathogens pose a public health threat. This study determined the incidence of multidrug-resistant (MDR) and extended spectrum beta lactamase (ESBL)-producing <i>E. coli</i> using the ATLAS global dataset from 64 countries on 6 continents between 2004 and 2022. <h3>Result</h3> Our findings revealed that 26.6 % (n = 30,102/113,139) of the isolates expressed phenotypic MDR profiles, whereas ESBL production was detected in 18.79 % (n = 21,264/113,139). The annual incidence of MDR and ESBL-producing <i>E. coli</i> per 1,000 population per year was, respectively, 12.38 and 12.95 cases in Africa, 12.93 and 4.88 cases in Oceania, 14.41 and 17.16 cases in Asia, 15.36 and 15.22 cases in North America, 15.48 and 11.78 cases in South America, and 15.66 and 9.11 cases in Europe. The hierarchical model revealed that the economic status (lower-middle income, aOR: 1.14; 95 % CI:1.06, 1.23), continent (South America, aOR: 1.21; 95 % CI:1.07, 1.37), and unrestricted over-the-counter (OTC) sale of antibiotics (aOR: 1.10; 95 % CI: 1.02, 1.18) were significantly associated with the occurrence of an MDR phenotype. The factors that predicted ESBL production were the economic status (upper-middle income, aOR: 1.40; 95 %CI: 1.29, 1.52), human development index (medium, aOR:1.57; 95 %CI: 1.44, 1.70), continent (Asia, aOR: 3.02; 95 % CI: 2.75, 3.31), lower healthcare expenditure (<5 % of GDP)(aOR:0.52; 95 %CI: 0.48, 0.56), gross national product of US $10,000–30,000 (aOR: 1.36; 95 %CI:1.17, 1.58), and OTC sale of antibiotics (aOR: 3.27; 95 % CI: 2.99, 3.57). <h3>Conclusion</h3> This study provided a global overview of MDR and ESBL-producing <i>E. coli</i>, as well as their associated factors. There are serious data gaps in many low- and middle-income settings, emphasizing the need to strengthen the microbiological laboratory capacity, diagnostic stewardship, and data management systems.