Expression of multidrug efflux pump gene acrAB in Escherichia coli: a systematic review and meta analysis
Abstract
Background: Multidrug-resistant (MDR) Escherichia coli (E.coli) is a growing public health concern, largely driven by the overexpression of efflux pumps such as AcrAB-tolC. These efflux systems contribute to resistance against multiple antibiotic classes, including fluoroquinolones, β-lactams, and aminoglycosides. Despite the well-documented role of efflux pumps in resistance, inconsistencies in reported expression levels and regulatory mechanisms complicate the development of targeted therapies. This systematic review and meta-analysis aim to consolidate available evidence on acrAB-tolC expression patterns and evaluate the impact of efflux pump inhibitors (EPIs) on antibiotic susceptibility.
Methods: A systematic search was conducted in PubMed, Scopus, Google Scholar, and EBSCO to identify relevant studies examining acrAB expression in E.coli under antibiotic exposure conditions. Inclusion criteria encompassed experimental studies utilizing qPCR, RNA-seq, or microarray techniques to quantify acrAB expression, as well as research assessing the efficacy of EPIs in restoring antibiotic susceptibility. Data synthesis was performed using a random-effects meta-analysis model, and heterogeneity was assessed using the I² statistic.
Results: A total of 10 studies were included in the final meta-analysis. Pooled analysis demonstrated a significant increase in acrAB expression (SMD: 3.5, 95% CI: 2.1-4.9) in MDR E.coli isolates compared to susceptible strains. Efflux inhibition…
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Evidence Hub reads this as a meta-analysis. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid.
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