Antimicrobial resistance poses a significant challenge to global health, particularly concerning bacteria in the food we consume. Pathogens such as Escherichia coli, commonly found in milk and dairy products, are increasingly resistant to multiple antimicrobials due to the overuse and misuse of these drugs in both human medicine and agricultural practices. This study aimed to investigate the prevalence and resistance rate to various antimicrobials of E. coli isolated from bovine milk and dairy products. A total of 236 studies, encompassing 287,792 E. coli isolates, were included in the network meta-analysis. Additionally, 197 studies, contributing 93,746 E. coli isolates, were used for meta-analysis of E. coli prevalence. A Bayesian approach and Markov chain Monte Carlo simulations were employed for antimicrobial resistance data analysis. The results were presented as odds ratios along with 95% credible intervals. The surface under the cumulative ranking curve was applied to rank antimicrobials and antimicrobial classes. Network meta-regressions were carried out to investigate the impact of variables such as sample sizes, pathogenicity of E. coli strains, animal health status, location of study conducted, and development status of country where study conducted on the overall results. The prevalence of E. coli in milk and dairy products was 25% globally. The outcomes indicated a notable resistance among E. coli isolates sourced from bovine milk and related products toward penicillins and sulfonamides. Conversely, resistance to newer generations of antimicrobials such as carbapenems (imipenem and meropenem) and fluoroquinolones (levofloxacin) was notably lower in E. coli isolates. Noteworthy lower resistance was also observed among other antimicrobial categories, including polymyxins (colistin) and fourth-generation cephalosporin (cefepime) antimicrobials. The study also underscored a significant difference in resistance levels between pathogenic and nonpathogenic strains of E. coli, with pathogenic strains displaying notably higher resistance levels (39.18% vs. 30.17%). Furthermore, geographical disparities in antimicrobial resistance were evident, with E. coli isolates from developing countries exhibiting markedly higher resistance levels compared with those from developed countries (36.86% vs. 23.22%). Lastly, the predictive analysis conducted in this study indicated that by the year 2040, it is anticipated that over half of E. coli isolates will be resistant to current antimicrobial agents, showing a troubling projection of increasing antimicrobial resistance among E. coli strains. This network meta-analysis offers a comprehensive examination of global resistance trends and their evolving nature. Although resistance to carbapenems and fourth-generation cephalosporins was found to be lower, increasing resistance in general underlines the urgent requirement for multifaceted treatment approaches to maintain the efficacy of antimicrobials against E. coli, particularly its pathogenic strains.
