Antibiotic resistance in Indonesia: A systematic review and meta-analysis of extended-spectrum beta-lactamase-producing bacteria (2008–2024)

Objective: Extended-spectrum beta-lactamase-producing bacteria pose a significant threat to public health due to their resistance to commonly used antibiotics. This meta-analysis aims to determine the prevalence and distribution of extended-spectrum beta-lactamase-producing bacteria in Indonesia. Methods: This systematic review and meta-analysis adhere to PRISMA guidelines to estimate the prevalence of extended-spectrum beta-lactamase-producing bacteria in Indonesia from 2008 to 2024. Systematic searches were conducted by PubMed, ScienceDirect, Google Scholar, and Index Medicus, and data were analyzed using a random-effects model to address heterogeneity. Results: A systematic search yielded 1160 records. After duplicate removal and eligibility screening, 64 studies were included in the qualitative synthesis, and 48 were suitable for quantitative analysis. The pooled prevalence of extended-spectrum beta-lactamase-producing-producing bacteria in Indonesia was 46.38% (95% CI: 39.55%–53.21%) with significant heterogeneity (I² = 99.05%), reflecting substantial variability in methodologies, populations, and regional contexts. While Sumatra shows the highest prevalence at 63.99% (95% CI: 62.09%–65.89%) and Kalimantan the lowest at 15.24% (95% CI: 9.45%–21.02%), these findings must be interpreted with caution due to the significant heterogeneity. In hospitals, the prevalence was 47.13% (95% CI: 39.71%–54.54%), and in community was 47.26% (95% CI: 26.47%–59.95%). Adults had a higher prevalence (44.56%, 95% CI: 35.48%–53.64%) than children (32.38%, 95% CI: 20.85%–43.91%). The prevalence of extended-spectrum beta-lactamase-producing Escherichia coli was 57.84% (95% CI: 45.97%–69.72%), and Klebsiella pneumoniae was 51.03% (95% CI: 41.19%–60.86%). Conclusion: These findings highlight the urgent need for stringent infection control measures, tailored surveillance programmes, and effective antibiotic stewardship in Indonesia to mitigate the impact of extended-spectrum beta-lactamase-producing bacteria on public health. The substantial heterogeneity underscores the complexity of antimicrobial resistance epidemiology in Indonesia, necessitating cautious interpretation of pooled prevalence and standardised methodologies for future research to ensure accurate prevalence estimates.