Antibiotic Resistance in Enterobacteriaceae: Mechanisms, Prevalence, and Public Health Impact: A Review

Abstract

Antibiotic resistance (AR) has emerged as a critical global health challenge, threatening the effectiveness of modern medicine, food security, and sustainable development. This review explores the underlying mechanisms, current trends, and regional distributions of antibiotic resistance, with a focus on Enterobacteriaceae—a major family of gram-negative bacteria responsible for a wide range of hospital- and community-acquired infections. The misuse and overuse of antibiotics in human and veterinary medicine, coupled with poor infection control practices and environmental dissemination, have accelerated the emergence of resistant strains such as extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae, as well as carbapenem-resistant Enterobacteriaceae (CRE). Globally, resistance rates to third-generation cephalosporins, fluoroquinolones, and aminoglycosides are alarmingly high, with MDR strains increasingly reported in clinical settings. The situation in the Middle East is particularly concerning, where high resistance rates are documented across Iraq, Iran, Saudi Arabia, Egypt, Turkey, and conflict-affected regions like Syria and Yemen. Factors such as political instability, unregulated antibiotic access, and under-resourced healthcare systems contribute significantly to the problem. Additionally, environmental reservoirs and zoonotic transmission play an emerging role in the spread of resistance genes. Addressing antibiotic resistance requires coordinated international action, enhanced surveillance, antimicrobial stewardship, investment in novel therapeutics, and a one health approach that integrates human, animal, and environmental health. This review underscores the urgent need for comprehensive interventions to curb the rising tide of antibiotic resistance in Enterobacteriaceae and safeguard global health.