Iran's Escherichia coli AMR Landscape (2010–2025): A One Health Systematic Review and Meta‐Analysis

ABSTRACT Escherichia coli ( E. coli ) has developed resistance to multiple antibiotic classes, complicating treatment in both human and veterinary medicine. This study assesses the prevalence of antimicrobial resistance and antimicrobial resistance genes in E. coli in Iran, within a One Health framework encompassing humans, animals, foods, and the environment. We systematically searched Scopus, Google Scholar, Magiran, PubMed, Scientific Information Database Library (SID), and Web of Science, using keywords related to AMR and Escherichia coli , restricting to English and Persian publications from 2010 to January 2025. The risk of bias was evaluated using the JBI checklist for prevalence studies. Pooled prevalence and 95% confidence intervals (CIs) were calculated for each antibiotic using random‐effects models. A total of 368 studies were included in the meta‐analysis. The highest resistance was observed in the Classes of Penicillins (71.7, 95% CI: 65.6–76.6) and the lowest for Fosfomycins (6.8, 95% CI: 5.2–8.5). Resistance to Ceftizoxime, Ertapenem, Streptomycin, Piperacillin‐Tazobactam, and Colistin increased over time. Phenotypically, 47.2%, 20.2%, and 14.1% of E. coli isolates were identified as extended‐spectrum β‐lactamase‐producing (ESBL), AmpC, and metallo‐beta‐lactamase (MBL) producing, respectively. Among ESBL‐producing isolates, the prevalence of bla CTX‐M , bla TEM , and bla SHV genes was 68.2%, 58.5%, and 24.4%, respectively. The high prevalence of AMR highlights the critical need for robust antimicrobial stewardship within a One Health framework to preserve antibiotic efficacy. Our study provides essential baseline data across human, animal, and environmental sectors in Iran, forming a basis for future One Health strategies and policy‐making.