Ocorrência e características moleculares de Enterobactérias resistentes ao carbapenem recuperadas da fauna selvagem: uma revisão sistemática e metanálise

Resumo original em inglês

O que aconteceu

Carbapenem-resistant Enterobacteriaceae (CRE) represent a critical concern in the antimicrobial resistance (AMR) landscape due to their resistance to critical last-line antibiotics and their capacity for horizontal gene transfer. Although CRE are well described in clinical and livestock settings, evidence from wildlife remains scattered, limiting understanding of their ecological distribution outside managed systems. We conducted a systematic review and meta-analysis following PRISMA guidelines, screening 6,988 records published between January 2000 and July 2025 across three databases (PubMed, Scopus, and Web of Science), and 19 studies met the inclusion criteria. Using a random-effects model, the pooled CRE-positive proportion among recovered Enterobacteriaceae isolates tested for carbapenem resistance was estimated at 74.49% (95% CI: 49.75%-94.04%), with substantial between-study heterogeneity (I 2 = 96%). However, this isolate-level estimate should not be interpreted as the prevalence of CRE carriage among wild animals. Species-level stratification revealed CRE-positive proportions of 76.51% for Escherichia coli, 72.41% for Klebsiella spp., and 86.46% for other Enterobacteriaceae genera, including Citrobacter and Enterobacter spp.; however, these subgroup estimates should be interpreted cautiously, as confidence intervals were wide and heterogeneity remained substantial across several analyses. The highest descriptive estimate was observed in water-associated environments (84.49%), while differences among sampling environments were not statistically significant. Although pooled estimates varied descriptively across host taxonomic order, carbapenem agent, continent, and phenotypic susceptibility testing method, only sample type showed a statistically significant subgroup difference (p blaNDM, blaKPC, blaOXA-48-like, blaVIM, and blaIMP, and diverse sequence types were reported across continents. Given the highly restricted veterinary use of carbapenems, these findings are consistent with potential exposure to resistant bacteria or resistance determinants originating from anthropogenically influenced environments; however, transmission direction cannot be established from the available evidence. Overall, wildlife may serve as useful sentinels of environmental CRE contamination, while longitudinal surveillance and genomic transmission studies are needed to clarify their role in CRE persistence and dissemination.

Resumo publicado sob licença CC BY. A tradução para o português ainda não chegou a este estudo.