Twenty-Five Years of Escherichia coli Antimicrobial Resistance in Bangladesh: A One Health Review of Phylogeny and Trends

Abstract

Antimicrobial resistance (AMR) of Escherichia coli in Bangladesh is a multifaceted public health concern, featuring extensive multidrug resistance across clinical, environmental, and poultry sectors. The review aimed to address gaps in understanding prevalence, phylogenetic diversity, transmission dynamics, intervention effectiveness within a One Health framework, and to evaluate the resistance distribution across the human, animal, and environmental sectors from 2000 to 2025. The review employed diverse methodologies, including phenotypic antimicrobial susceptibility testing, molecular detection of resistance genes, whole genome sequencing, and phylogenetic analyses, reflecting a multidisciplinary One Health approach. Findings revealed widespread multidrug-resistant and extended-spectrum β-lactamase-producing E. coli with high prevalence in poultry, humans, and environmental reservoirs; diverse phylogenetic lineages, including high-risk clones such as ST131; and frequent detection of plasmid-mediated resistance genes like blaCTX-M variants and mcr-1 facilitating horizontal gene transfer. This paper also evaluates different AMR mitigation strategies reported in the literature, such as the urgent need for standardized, integrated surveillance employing phenotypic testing, molecular characterization, deepened understanding of resistance determinants, genetic diversity, and risk factors, implementation of regular workshops reducing unnecessary antibiotic use & coordinated One Health strategies. This review is the first to integrate 25-year temporal trends, phylogenetic diversity, and One Health transmission dynamics of E. coli antimicrobial resistance in Bangladesh.