Distribution and antimicrobial resistance of Enterobacteriaceae in food sources in South Africa: a systematic review

Enterobacteriaceae are commonly found foodborne pathogens that present serious public health risks because of their ability to acquire and spread antimicrobial resistance (AMR). This systematic review investigates the prevalence, distribution, and AMR profiles of Enterobacteriaceae isolated from food sources across South Africa. Peer reviewed articles published between January 2016, and December 2025 were synthesized following PRISMA 2020 principles. Out of 6,403 records identified through searches in PubMed, Google Scholar, Semantic Scholar, and AJOL, 28 studies met the eligibility criteria. Data were extracted and narratively synthesized on the distribution of Enterobacteriaceae , food sources, geographic representation, and AMR characteristics. The review covered a variety of food types and provinces, with fruits, vegetables, and raw meat being the most frequently studied. The most reported species were Escherichia coli (57.1%), followed by Klebsiella spp. (25%) and Salmonella spp. (28.5%). High provincial occurrence was noted, particularly Salmonella spp. in Gauteng and E. coli in the Eastern Cape. AMR profiles showed widespread resistance to cephalosporins, carbapenems, fluoroquinolones, aminoglycosides, phenicol’s, tetracyclines, and penicillin. Major genera displayed multidrug-resistant (MDR) status, with Klebsiella spp. resistant to at least eight antibiotic classes and Salmonella spp. resistant to at least nine. This review highlights the high presence of MDR Enterobacteriaceae in South African food systems, with raw meat and vegetables acting as important reservoirs. To reduce AMR transmission along the farm-to-fork continuum, the findings emphasize the critical need for coordinated surveillance, strengthened food safety practices, and integrated “One Health” initiatives.