Published in PLOS One on 2026-08-24, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Amanuale Zayede, Yitayih Wondimeneh, Sirak Biset, Mitkie Tigabie, Henok Worku, Biruktawit Abebe, Haymanot Tilahun, Eshet Gebrie, Mucheye Gizachew
Source: PLOS One • DOI 10.1371/journal.pone.0340571
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Antimicrobial resistance caused by extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-PE) has emerged as a major threat to global public health. The human gastrointestinal tract represents a critical ecological niche for these organisms, enabling silent carriage and onward transmission. Food handlers are of particular concern because they can facilitate indirect transmission of resistant bacteria through food preparation and handling. Despite the availability of primary studies, evidence focusing specifically on food handlers in Africa remains fragmented. This systematic review and meta-analysis therefore aimed to estimate the pooled prevalence of fecal colonization with ESBL-PE among food handlers in Africa.
This review was conducted according to a protocol registered in PROSPERO (ID: CRD420251075141). A systematic search was performed from September 5–15, 2025 in PubMed, Google Scholar, and Hinari/Research4Life to identify relevant studies. The methodological quality of the included studies was appraised using the Joanna Briggs Institute (JBI) critical appraisal tool. Data were extracted into Microsoft Excel 2019 and analyzed with Stata software version 17. Given significant heterogeneity among the studies (I2 = 98.3%, p < 0.001), a random-effects model (DerSimonian and Laird) was used to calculate the pooled prevalence. To investigate the substantial heterogeneity, we performed subgroup and sensitivity analysis. The potential for publication bias was assessed using funnel plot and Egger’s test.
The meta-analysis incorporated nine studies with publication year ranged between 2012 and 2023, involving 4,061 participants. The pooled fecal colonization rate of ESBL-PE among food handlers in Africa was 23.64% (95% CI: 15.3, 31.94%). A high degree of heterogeneity was observed (I2 = 98.3%, p < 0.001). The most prevalent ESBL-PE species identified was E. coli, with a pooled prevalence of 85.83% (95% CI: 79.97, 91.69%, I2 = 95.56%, p < 0.001), followed by Klebsiella species at 23.92% (95% CI: 18.48, 29.35%, I2 = 0.00%, p = 0.65).
This meta-analysis demonstrates that approximately one in four food handlers were identified as ESBL-PE carriers in Africa based on pooled estimates. These findings highlight the need for strengthened food safety regulations, routine screening of high-risk occupational groups, and enhanced antimicrobial stewardship programs to limit the spread of resistant Enterobacteriaceae.
Introduction
Enterobacteriaceae comprise a diverse group of Gram-negative bacteria that commonly inhabit the intestinal tract of humans and animals, while also causing a wide range of community- and healthcare-associated infections [1,2]. Of particular concern are ESBL-producing Enterobacteriaceae (ESBL-PE), which have been classified by the World Health Organization (WHO) as critical-priority pathogens due to their resistance profile and public health impact [3]. Species such as Escherichia coli and Klebsiella pneumoniae are among the most frequently identified ESBL producers and are responsible for severe infections worldwide [4]. The Infectious Diseases Society of America (IDSA) has identified them as two of the six pathogens for which new drugs are urgently required to address the issue of resistance development [5]. According to the Global antimicrobial resistance (AMR) and Use Surveillance System (GLASS) Report 2022, resistance rates to meropenem and third-generation cephalosporins in E. coli infections increased by more than 15% in 2020 compared to 2017 [6].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Amanuale Zayede, Yitayih Wondimeneh, Sirak Biset, Mitkie Tigabie, Henok Worku, Biruktawit Abebe, Haymanot Tilahun, Eshet Gebrie, Mucheye Gizachew. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
Explore connected evidence
- Evidence brief: Fecal carriage of ESBL and Carbapenemase-producing Enterobacteriaceae, and its associated factors among hospital and non-hospital janitors at the University of Gondar, Northwest Ethiopia: A comparative cross-sectional study
- Evidence brief: Prevalence and associated factors of Leukemia in Africa: A systematic review and meta-analysis
- Evidence brief: Contamination of Hospital Inanimate Surfaces with Methicillin-Resistant Staphylococcus aureus and Extended-Spectrum Beta-Lactamase producing bacteria at Ocean Road Cancer Institute, Dar es Salaam, Tanzania
