A One Health view of antimicrobial resistance in North Africa: Meta-analysis of ESBL-producing Enterobacteriaceae across sectors

Background: Antimicrobial resistance is a growing global health threat, and extended-spectrum β-lactamase-producing Enterobacterales exemplify a critical challenge. Because these organisms circulate across human, animal, food, and environmental reservoirs, a One Health perspective is essential for understanding their epidemiology. However, comprehensive regional syntheses remain limited in North Africa. Methods: This systematic review and meta-analysis synthesized evidence from 182 studies published between 2000 and 2024 on ESBL-producing Enterobacterales across North Africa within a One Health framework. We analyzed epidemiological data from human, animal, food, and environmental sources, as well as reported resistance genes, mobile genetic elements, transferability patterns, and clonal diversity associated with ESBL dissemination in the region. Results: ST101, ST147, and ST15. Conclusion: ESBL-producing Enterobacterales are widely disseminated across interconnected human, animal, food, and environmental compartments in North Africa. Their regional epidemiology is shaped by a high human burden, substantial environmental reservoirs, frequent multidrug resistant backgrounds, mobile genetic elements, horizontal gene transfer, and the circulation of multiple clonal lineages. These findings highlight the need for strengthened and integrated One Health surveillance in North Africa.