Imipenem resistance in Escherichia coli isolates from ICU patients: A systematic review and meta-analysis
Abstract
Background: Imipenem resistance in Escherichia coli within intensive-care settings (ICU) compromises effective empiric and targeted therapy and is associated with worse outcomes.
Objectives: To quantify the global prevalence of imipenem-resistant E. coli (IR-EC) in ICU/NICU isolates, characterize between-study heterogeneity and temporal trends, and summarize distribution patterns by geography, health-system context, and laboratory methods.
Methods: We searched PubMed/MEDLINE, EMBASE, Scopus, and Web of Science from inception to 1 June 2025. Observational studies reporting IR-EC proportions (R/N) in ICU/NICU were included. Random-effects meta-analysis of proportions (variance-stabilized; back-transformed) was conducted. Heterogeneity (Q, τ2, I2), subgroup analyses (country/WHO region, income level, AST method/guideline, period), and year-wise meta-regression were prespecified. Small-study effects were examined with Begg/Egger tests and Doi plot with LFK index; trim-and-fill assessed robustness. Risk of bias used the JBI prevalence checklist.
Results: Forty-two studies comprising 15,227 isolates (752 resistant) were included from multiple countries and WHO regions. The pooled IR-EC prevalence was 9.5% (95% CI 5.6-15.7%; Q(41) = 1462.276, I2 = 97.2%, p < 0.001). Trim-and-fill yielded 10.3% (95% CI 6.0-17.0%). Prevalence varied markedly: lowest in the United States (0.5%) and highest in Peru (85.7%). By WHO region, the Western Pacific pooled at 4.6% versus 38.4% in South-East…
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