Prevalence of Extended Spectrum Beta Lactamase Producing Escherichia Coli in Urinary Tract Infections in Nepal: A Systematic Review and Meta Analysis

Abstract

Extended Spectrum Beta Lactamase producing E. coli (ESBL Ec) has been reported from urinary tract infection cases in tertiary care hospitals of Nepal. Despite its significance as antimicrobial resistance indicator, comprehensive national data is lacking for implementation of effective national action plans. The main aim is to determine the pooled prevalence and temporal trends of ESBL Ec in Nepal. Studies from January 2006 to January 2026 were included following PRISMA guidelines; risk of bias was assessed using AXIS tool, and random-effects model was applied to estimate pooled prevalence and heterogeneity. Funnel plot asymmetry was evaluated using Egger’s weighted regression, temporal trends were analyzed by meta-regression, and meta-analyses were performed using CMA software (version 4). The pooled prevalence of ESBL Ec was 31.3% (95% CI: 26.436.1; p < 0.001) with significant heterogeneity (I2 = 94.35%, p < 0.001). Egger’s regression test indicated statistically significant small-study effects (β₀ = 5.84, p < 0.0001) in conjunction with funnel plot asymmetry. ESBL E. coli prevalence increased significantly in 2023 (coefficient = 0.723, p < 0.0001) and 2025 (coefficient = 0.569, p < 0.0001) corroborated by an upward trend in the bubble plot (2019–2025). Reserve antibiotics, colistin and tigecycline, have been used to treat ESBL Ec since 2017. The findings indicate a rising prevalence of ESBL Ec in urinary tract infections in Nepal over recent years. The reliance on reserve-category antibiotics in tertiary care centers further highlights the necessity for robust nationwide antimicrobial resistance surveillance within all provinces of Nepal.