Tracking Extended-Spectrum Beta Lactamase-Producing <i>Enterobacterales</i> Across One Health Among Bedouin Communities

<i><b>Background.</b></i> Health inequality is an important determinant of antimicrobial resistance (AMR), which is often understudied. The objective of this study was to investigate extended-spectrum beta lactamase-producing (ESBL-P) <i>Enterobacterales</i> from a One Health perspective (holistically approaching human, animal, and environmental health as linked), among the Bedouin, an indigenous pastoralist community. <i><b>Methods.</b></i> Extended-spectrum beta lactamase-producing isolates from clinical urinary samples (n = 98), greywater (n = 47), sewage (n = 11), surface water (n = 24), animal fecal (n = 9), and milk (n = 1) were subject to phenotypic testing using VITEK-2 and short-read sequencing followed by analyses of resistomes, mobilomes, and phylogeny. <i><b>Results.</b></i> Extended-spectrum beta lactamase-producing isolates from diverse sources, mainly <i>Escherichia coli</i> and <i>Klebsiella</i> sp., exhibited a wide range of significant antibiotic resistance genes (ARGs) with <i>bla</i>CTX-M as the key ESBL gene. High-risk clones (eg, ST131 and ST38) were noted, most commonly among environmental and clinical <i>E. coli</i> isolates. Environmental and clinical isolates exhibited potential relatedness, despite coming from different locations and sample types. Most predicted plasmids were <i>lnc</i>-type and harbored at least one beta-lactamase gene, including <i>bla</i>CTX-M-15. <i><b>Conclusions.</b></i> Extended-spectrum beta lactamase-producing isolates from the living environment of Bedouins exhibited a wide range of ARGs of public health interest. Environment-human and environment-animal clusters of isolates and plasmids were identified. Further research is needed to establish the transmission dynamics of AMR and related mobile elements across One health in this setting and related risks.