Pooled prevalence of third-generation cephalosporin resistance among Escherichia coli bloodstream isolates in Southeast Asia: protocol for systematic review and meta-analysis
Year: 2026
Type: review
Study design: Study Protocol
Abstract: Introduction Bloodstream infections remain a major contributor to global infectious disease mortality, and antimicrobial resistance increasingly compromises effective empirical and definitive treatment. Escherichia coli is among the leading bacterial causes of bloodstream infections and a major pathogen associated with antimicrobial resistance-related mortality. Resistance to third-generation cephalosporins, including ceftriaxone, cefotaxime and ceftazidime, is clinically important because it may limit standard treatment options and increase reliance on broader-spectrum agents. In Southeast Asia, available data on third-generation cephalosporin-resistant E. coli bloodstream isolates remain fragmented across countries, hospitals, populations and study designs. This systematic review and meta-analysis aims to estimate the pooled prevalence of third-generation cephalosporin resistance (3GCR) among E. coli bloodstream isolates in Southeast Asia. Methods and analysis This protocol will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guideline and has been registered in PROSPERO under registration number CRD420261381302. Searches will be conducted in PubMed, Scopus, ScienceDirect and Google Scholar from database inception to 1 October 2026, supplemented by citation searching and reference list screening. Eligible studies will include cross-sectional, surveillance, cohort, retrospective laboratory database and prospective observational studies conducted in Southeast Asian countries that report blood culture-specific data on third-generation cephalosporin resistance among E. coli isolates. Studies reporting ceftriaxone, cefotaxime or ceftazidime resistance, or ESBL phenotype clearly representing third-generation cephalosporin resistance, will be considered. Title and abstract screening will be performed independently by three reviewers. Full-text assessment, data extraction and quality assessment will be performed independently by two reviewers, with disagreements resolved through discussion with a third reviewer. Methodological quality will be assessed using a modified version of the Newcastle-Ottawa Scale. The primary outcome will be the pooled prevalence of third-generation cephalosporin resistance among E. coli bloodstream isolates. A random-effects meta-analysis will be used, with planned subgroup analyses by country, age group and infection-acquisition setting. Temporal trends will be explored using the year of data collection or publication. Ethics and dissemination Ethical approval is not required because this study will synthesise data from previously published studies and will not involve direct recruitment of human participants or collection of individual patient data. The findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO registration number CRD420261381302.
Source: BMJ Open
Institutions: Universitas Airlangga, National University of East Timor
Language: English
Subfield: Microbiology (medical)
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $1,839
Funder: Universitas Airlangga
OpenAlex ID: W7223057784