{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T16:33:55Z","timestamp":1782146035902,"version":"3.54.5"},"reference-count":52,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T00:00:00Z","timestamp":1603065600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI135118"],"award-info":[{"award-number":["R01AI135118"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Community-acquired antimicrobial resistant Enterobacteriaceae (CA-ARE) are an increasingly important issue around the world. Characterizing the distribution of regionally specific patterns of resistance is important to contextualize and develop locally relevant interventions. This systematic review adopts a One Health framework considering the health of humans, animals, and the environment to describe CA-ARE in Central America. Twenty studies were identified that focused on antimicrobial resistance (AMR) in Enterobacteriaceae. Studies on CA-ARE in Central America characterized resistance from diverse sources, including humans (n = 12), animals (n = 4), the environment (n = 2), and combinations of these categories (n = 2). A limited number of studies assessed prevalence of clinically important AMR, including carbapenem resistance (n = 3), third generation cephalosporin resistance (n = 7), colistin resistance (n = 2), extended spectrum beta-lactamase (ESBL) production (n = 4), or multidrug resistance (n = 4). This review highlights significant gaps in our current understanding of CA-ARE in Central America, most notably a general dearth of research, which requires increased investment and research on CA-ARE as well as AMR more broadly.<\/jats:p>","DOI":"10.3390\/ijerph17207622","type":"journal-article","created":{"date-parts":[[2020,10,19]],"date-time":"2020-10-19T20:44:41Z","timestamp":1603140281000},"page":"7622","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Community-Acquired Antimicrobial Resistant Enterobacteriaceae in Central America: A One Health Systematic Review"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1770-9190","authenticated-orcid":false,"given":"Lauren","family":"O\u2019Neal","sequence":"first","affiliation":[{"name":"School of Public Health, University of California, Berkeley, CA 94720, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6413-4524","authenticated-orcid":false,"given":"Danilo","family":"Alvarez","sequence":"additional","affiliation":[{"name":"Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renata","family":"Mendiz\u00e1bal-Cabrera","sequence":"additional","affiliation":[{"name":"Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8527-4067","authenticated-orcid":false,"given":"Brooke M.","family":"Ramay","sequence":"additional","affiliation":[{"name":"Center for Health Studies, Universidad del Valle de Guatemala, Guatemala City 01015, Guatemala"},{"name":"Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA 99164, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7062-6293","authenticated-orcid":false,"given":"Jay","family":"Graham","sequence":"additional","affiliation":[{"name":"School of Public Health, University of California, Berkeley, CA 94720, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,19]]},"reference":[{"key":"ref_1","unstructured":"World Health Organization (2017). Global Priority List of Antibiotic-Resistant Bacteria to Guide Research, Discovery, and Development of New Antibiotics, World Health Organization. Available online: https:\/\/www.who.int\/medicines\/publications\/WHO-PPL-Short_Summary_25Feb-ET_NM_WHO.pdf."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Van Boeckel, T.P., Pires, J., Silvester, R., Zhao, C., Song, J., Criscuolo, N.G., Gilbert, M., Bonhoeffer, S., and Laxminarayan, R. (2019). Global trends in antimicrobial resistance in animals in low- and middle-income countries. Science, 365.","DOI":"10.1126\/science.aaw1944"},{"key":"ref_3","unstructured":"World Health Organization (2015). Worldwide Country Situation Analysis: Response to Antimicrobial Resistance, World Health Organization."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/S0140-6736(15)00473-0","article-title":"Understanding the mechanisms and drivers of antimicrobial resistance","volume":"387","author":"Holmes","year":"2016","journal-title":"Lancet"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1146\/annurev.publhealth.29.020907.090904","article-title":"Industrial food animal production, antimicrobial resistance, and human health","volume":"29","author":"Silbergeld","year":"2008","journal-title":"Annu. Rev. Public Health"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Graham, J.P., Eisenberg, J.N.S., Trueba, G., Zhang, L., and Johnson, T.J. (2017). Small-Scale Food Animal Production and Antimicrobial Resistance: Mountain, Molehill, or Something in-between?. Environ. Health Perspect., 125.","DOI":"10.1289\/EHP2116"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Frost, I., Van Boeckel, T.P., Pires, J., Craig, J., and Laxminarayan, R. (2019). Global geographic trends in antimicrobial resistance: The role of international travel. J. Travel. Med., 26.","DOI":"10.1093\/jtm\/taz036"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"704","DOI":"10.1093\/cid\/cit355","article-title":"The scourge of antibiotic resistance: The important role of the environment","volume":"57","author":"Finley","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_9","first-page":"173","article-title":"Dissemination of Antimicrobial Resistance in Microbial Ecosystems through Horizontal Gene Transfer","volume":"7","author":"Penders","year":"2016","journal-title":"Front. Microbiol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"132","DOI":"10.1016\/S1473-3099(17)30704-1","article-title":"Why the antibiotic resistance crisis requires a One Health approach","volume":"18","author":"Deborggraeve","year":"2018","journal-title":"Lancet Infect. Dis."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1146\/annurev-food-041715-033251","article-title":"Antimicrobial Resistance, Food Safety, and One Health: The Need for Convergence","volume":"7","author":"Lammie","year":"2016","journal-title":"Annu. Rev. Food Sci. Technol."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Collignon, P.J., and McEwen, S.A. (2019). One Health\u2014Its Importance in Helping to Better Control Antimicrobial Resistance. Trop. Med. Infect. Dis., 4.","DOI":"10.3390\/tropicalmed4010022"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Moreno, P., Cer\u00f3n, A., Sosa, K., Morales, M., Grajeda, L.M., Lopez, M.R., McCraken, J.P., Cord\u00f3n-Rosales, C., Palmer, G.H., and Call, D.R. (2020). Availability of over-the-counter antibiotics in Guatemalan corner stores. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0239873"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Ramay, B.M., Lambour, P., and Cer\u00f3n, A. (2015). Comparing antibiotic self-medication in two socio-economic groups in Guatemala City: A descriptive cross-sectional study. BMC Pharmacol. Toxicol., 16.","DOI":"10.1186\/s40360-015-0011-3"},{"key":"ref_15","first-page":"24","article-title":"Resistencia bacteriana en infecciones del tracto urinario de origen comunitario","volume":"20","author":"Villatoro","year":"2016","journal-title":"Rev. Med. Interma Guatem"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"13767","DOI":"10.1038\/s41598-020-70741-4","article-title":"Antibiotic use and hygiene interact to influence the distribution of antimicrobial-resistant bacteria in low-income communities in Guatemala","volume":"10","author":"Ramay","year":"2020","journal-title":"Sci. Rep."},{"key":"ref_17","unstructured":"(2020, August 10). PAHO\/WHO ReLAVRA. Available online: https:\/\/www.paho.org\/hq\/index.php?option=com_content&view=article&id=6221:2017-relavra-mas-informacion&Itemid=42432&lang=en."},{"key":"ref_18","unstructured":"(2020, October 16). Annual Report of the Network for Monitoring\/Surveillance of Antibiotic Resistance and Health Care Associated Infections\u20142014. Revista de Patologia Tropical. Available online: https:\/\/www.paho.org\/hq\/dmdocuments\/2017\/2014-cha-informe-anual-relavra.pdf."},{"key":"ref_19","unstructured":"World Health Organization (2018). Global Antimicrobial Resistance Surveillance System (GLASS) Report: Early Implementation 2017\u20132018, World Health Organization. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/279656\/9789241515061-eng.pdf?ua=1."},{"key":"ref_20","unstructured":"World Health Organization (2020). Global Antimicrobial Resistance and Use Surveillance System (GLASS) Report: Early Implementation 2020, World Health Organization. Available online: https:\/\/apps.who.int\/iris\/bitstream\/handle\/10665\/332081\/9789240005587-eng.pdf?ua=1."},{"key":"ref_21","unstructured":"(2020, October 16). Plan de Accion Nacional de Lucha Contra la Resistencia a los Antimicrobianos Costa Rica 2018\u20132025. Available online: https:\/\/www.ministeriodesalud.go.cr\/index.php\/vigilancia-de-la-salud\/normas-protocolos-y-guias\/resistencia-microbiana\/3811-plan-de-accion-nacional-de-lucha-contra-la-resistencia-a-los-antimicrobianos-costa-rica-2018-2025\/file."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., Altman, D.G., and PRISMA Group (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_23","unstructured":"(2020, October 05). Covidence. Available online: http:\/\/www.covidence.org."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S20","DOI":"10.1016\/j.amjmed.2006.03.013","article-title":"Resistance in gram-negative bacteria: Enterobacteriaceae","volume":"119","author":"Paterson","year":"2006","journal-title":"Am. J. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2227","DOI":"10.1128\/AAC.01707-08","article-title":"Resistance plasmid families in Enterobacteriaceae","volume":"53","author":"Carattoli","year":"2009","journal-title":"Antimicrob. Agents Chemother."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"558","DOI":"10.1016\/j.mib.2010.09.006","article-title":"Alarming \u03b2-lactamase-mediated resistance in multidrug-resistant Enterobacteriaceae","volume":"13","author":"Bush","year":"2010","journal-title":"Curr. Opin. Microbiol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"216","DOI":"10.1099\/jmm.0.020842-0","article-title":"Antibiotic resistance patterns of intestinal Escherichia coli isolates from Nicaraguan children","volume":"60","author":"Amaya","year":"2011","journal-title":"J. Med. Microbiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1093\/infdis\/122.3.170","article-title":"Epidemic Shiga bacillus dysentery in Central America. I. Etiologic investigations in Guatemala, 1969","volume":"122","author":"Mata","year":"1970","journal-title":"J. Infect. Dis."},{"key":"ref_29","first-page":"169","article-title":"Prevalence of enteropathogenic and enterotoxigenic Escherichia coli in children with and without diarrhoea in Esteli, Nicaragua","volume":"11","author":"Mayatepek","year":"1993","journal-title":"J. Diarrhoeal. Dis. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"292","DOI":"10.4269\/ajtmh.2010.09-0412","article-title":"Diarrheagenic Escherichia coli in children from Costa Rica","volume":"83","author":"Arias","year":"2010","journal-title":"Am. J. Trop. Med. Hyg."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"P\u00e9rez-Corrales, C., and Leandro-Sand\u00ed, K. (2019). Diarrheagenic Escherichia coli in Costa Rican children: A 9-year retrospective study. BMC Res. Notes, 12.","DOI":"10.1186\/s13104-019-4313-1"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1080\/00034983.1988.11812227","article-title":"A preliminary investigation of antibiotic resistance in Enterobacteriaceae isolated from children with diarrhoea from four developing countries","volume":"82","author":"Shears","year":"1988","journal-title":"Ann. Trop. Med. Parasitol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e770","DOI":"10.1016\/j.ijid.2010.02.2264","article-title":"Increasing resistance in community-acquired urinary tract infections in Latin America, five years after the implementation of national therapeutic guidelines","volume":"14","author":"Bours","year":"2010","journal-title":"Int. J. Infect. Dis."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.ijantimicag.2003.10.003","article-title":"Resistance of uropathogens in symptomatic urinary tract infections in Le\u00f3n, Nicaragua","volume":"23","author":"Matute","year":"2004","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/S0924-8579(02)00244-3","article-title":"Antimicrobial resistance in Escherichia coli causing urinary tract infections in Costa Rica: A clinical dilemma","volume":"21","author":"Williams","year":"2003","journal-title":"Int. J. Antimicrob. Agents"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Villegas, M.V., Pallares, C.J., Escand\u00f3n-Vargas, K., Hern\u00e1ndez-G\u00f3mez, C., Correa, A., \u00c1lvarez, C., Rosso, F., Matta, L., Luna, C., and Zurita, J. (2016). Characterization and Clinical Impact of Bloodstream Infection Caused by Carbapenemase-Producing Enterobacteriaceae in Seven Latin American Countries. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0154092"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"4885","DOI":"10.1128\/JCM.42.10.4885-4888.2004","article-title":"Pediatric infection due to multiresistant Salmonella enterica serotype Infantis in Honduras","volume":"42","author":"Liebana","year":"2004","journal-title":"J. Clin. Microbiol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1795","DOI":"10.1093\/jac\/dks101","article-title":"Emergence of NDM-1-producing Klebsiella pneumoniae in Guatemala","volume":"67","author":"Pasteran","year":"2012","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1089\/vbz.2015.1785","article-title":"Salmonella Isolates in the Introduced Asian House Gecko (Hemidactylus frenatus) with Emphasis on Salmonella Weltevreden, in Two Regions in Costa Rica","volume":"15","author":"Abarca","year":"2015","journal-title":"Vector. Borne Zoonotic. Dis."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"852","DOI":"10.1111\/zph.12635","article-title":"Salmonellosis detection and evidence of antibiotic resistance in an urban raccoon population in a highly populated area, Costa Rica","volume":"66","author":"Baldi","year":"2019","journal-title":"Zoonoses Public Health"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1089\/fpd.2015.2050","article-title":"Vigilance for Salmonella in Feedstuffs Available in Costa Rica: Prevalence, Serotyping and Tetracycline Resistance of Isolates Obtained from 2009 to 2014","volume":"13","author":"Molina","year":"2016","journal-title":"Foodborne Pathog. Dis."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1642","DOI":"10.4315\/0362-028X.JFP-15-117","article-title":"Salmonella on Raw Poultry in Retail Markets in Guatemala: Levels, Antibiotic Susceptibility, and Serovar Distribution","volume":"78","author":"Jarquin","year":"2015","journal-title":"J. Food Prot."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"5870","DOI":"10.1128\/AEM.00963-06","article-title":"Lettuce for Human Consumption Collected in Costa Rica Contains Complex Communities of Culturable Oxytetracycline- and Gentamicin-Resistant Bacteria","volume":"72","author":"Lang","year":"2006","journal-title":"Appl. Environ. Microbiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"E347","DOI":"10.1111\/j.1469-0691.2012.03930.x","article-title":"Antibiotic resistance patterns of Escherichia coli isolates from different aquatic environmental sources in Le\u00f3n, Nicaragua","volume":"18","author":"Amaya","year":"2012","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1089\/mdr.2015.0323","article-title":"Fecal Carriage of Extended-Spectrum \u03b2-Lactamases in Healthy Humans, Poultry, and Wild Birds in Le\u00f3n, Nicaragua-A Shared Pool of blaCTX-M Genes and Possible Interspecies Clonal Spread of Extended-Spectrum \u03b2-Lactamases-Producing Escherichia coli","volume":"22","author":"Hasan","year":"2016","journal-title":"Microb. Drug Resist."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1038\/nature17672","article-title":"Interconnected microbiomes and resistomes in low-income human habitats","volume":"533","author":"Pehrsson","year":"2016","journal-title":"Nature"},{"key":"ref_47","unstructured":"Committee for Medicinal Products for Veterinary Use, and Committee for Medicinal Products for Human Use (2019). Categorisation of antibiotics in the European Union, European Medicines Agency. Available online: https:\/\/www.ema.europa.eu\/en\/documents\/report\/categorisation-antibiotics-european-union-answer-request-european-commission-updating-scientific_en.pdf."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Mitchell, M.E.V., Alders, R., Unger, F., Nguyen-Viet, H., Le, T.T.H., and Toribio, J.-A. (2020). The challenges of investigating antimicrobial resistance in Vietnam\u2014What benefits does a One Health approach offer the animal and human health sectors?. BMC Public Health, 20.","DOI":"10.1186\/s12889-020-8319-3"},{"key":"ref_49","doi-asserted-by":"crossref","unstructured":"R\u00fcegg, S.R., Nielsen, L.R., Buttigieg, S.C., Santa, M., Aragrande, M., Canali, M., Ehlinger, T., Chantziaras, I., Boriani, E., and Radeski, M. (2018). A Systems Approach to Evaluate One Health Initiatives. Front. Vet. Sci., 5.","DOI":"10.3389\/fvets.2018.00023"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1093\/jac\/dkx488","article-title":"Plasmids carrying antimicrobial resistance genes in Enterobacteriaceae","volume":"73","author":"Rozwandowicz","year":"2018","journal-title":"J. Antimicrob. Chemother."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1517\/14656566.2013.763030","article-title":"Evolution of antimicrobial resistance among Enterobacteriaceae (focus on extended spectrum \u03b2-lactamases and carbapenemases)","volume":"14","author":"Lynch","year":"2013","journal-title":"Expert Opin. Pharmacother."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.drup.2014.02.001","article-title":"Antimicrobial resistance among Enterobacteriaceae in South America: History, current dissemination status and associated socioeconomic factors","volume":"17","author":"Bonelli","year":"2014","journal-title":"Drug Resist. Update"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/20\/7622\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:24:13Z","timestamp":1760178253000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/20\/7622"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,19]]},"references-count":52,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["ijerph17207622"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17207622","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,19]]}}}