{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T19:08:03Z","timestamp":1793128083044,"version":"4.5.0"},"reference-count":88,"publisher":"IWA Publishing","issue":"5","license":[{"start":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T00:00:00Z","timestamp":1630540800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["iwaponline.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,10,1]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Wastewater is considered a hotspot niche of multi-drug and pathogenic bacteria such as Enterobacteriaceae-producing extended-spectrum beta-lactamases (ESBL-E). Thus, the aim of this meta-analysis was to evaluate the prevalence of ESBL-E in different wastewater sources. Different databases (Medline, EMBASE, and Cochrane Library) were searched from inception to March 2021. Data were analyzed using random-effects modeling, and subgroup and meta-regression analyses were used to ascertain heterogeneity among the subgroups. Fifty-seven observational studies were selected, and the pooled prevalence of ESBL-E in wastewater was 24.81% (95% CI, 19.28\u201330.77). Escherichia coli had the highest ESBL prevalence. The blaCTX-M genes were the most prevalent in the selected studies (66.56%). The pooled prevalence of ESBL was significantly higher in reports from America (39.91%, 95% CI, 21.82\u201359.51) and reports studying hospital and untreated wastewaters (33.98%, 95% CI, 23.82\u201344.91 and 27.36%, 95% CI, 19.12\u201336.42). Overall, this meta-analysis showed that the prevalence of ESBL-E in wastewater is increasing over time and that hospital wastewater is the most important repository of ESBL-E. Therefore, there is a need for developing new sewage treatment systems that decrease the introduction of resistant bacteria and antibiotic residues.<\/jats:p>","DOI":"10.2166\/wh.2021.112","type":"journal-article","created":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T16:12:02Z","timestamp":1630599122000},"page":"705-723","update-policy":"https:\/\/doi.org\/10.2166\/iwapcrossmarkpolicypage","source":"Crossref","is-referenced-by-count":50,"title":["Prevalence of extended-spectrum \u03b2-lactamase (ESBL)-producing<i>Enterobacteriaceae<\/i>in wastewater: a systematic review and meta-analysis"],"prefix":"10.2166","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6526-374X","authenticated-orcid":false,"given":"Nawel","family":"Zaatout","sequence":"first","affiliation":[{"name":"Faculty of Natural and Life Sciences, University of Batna 2, Batna, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0202-6234","authenticated-orcid":false,"given":"Samia","family":"Bouras","sequence":"additional","affiliation":[{"name":"Faculty of Natural and Life Sciences, University of Setif, Setif, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nouria","family":"Slimani","sequence":"additional","affiliation":[{"name":"Faculty of Natural and Life Sciences, University of Setif, Setif, Algeria"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"945","published-online":{"date-parts":[[2021,9,2]]},"reference":[{"key":"2021101915245367800_JWH-D-21-00112C1","first-page":"167","article-title":"Occurrence of multidrug resistant and extended spectrum \u03b2-lactamase (ESBL)\u2014 Escherichia coli in wastewater of two healthcare facilities in Ibadan, Nigeria","volume":"26","year":"2019","journal-title":"World News Nat. 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