Prevalence and drug resistance patterns of Gram-negative enteric bacterial pathogens from diarrheic patients in Ethiopia: A systematic review and meta-analysis.
Prevalence and drug resistance patterns of Gram-negative enteric bacterial pathogens from diarrheic patients in Ethiopia: A systematic review and meta-analysis.
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DOI：
10.1371/journal.pone.0265271
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Gelaw B
中科院分区：
文献类型：
--
作者：
Beyene AM;Gezachew M;Mengesha D;Yousef A;Gelaw B
腹泻是世界上发病率和死亡率的主要原因，特别是在发展中国家和弱势群体中。革兰氏阴性肠道细菌病原体（GNEBP）是一组主要存在于肠道并引起腹泻的微生物。抗菌剂通常是其治疗方案的一部分。抗微生物剂的治疗效果因耐药菌株的出现和传播而受到阻碍。关于埃塞俄比亚GNEBP的流行率和抗菌药物耐药模式的信息有限，并且以分散的形式存在。本研究的目的是确定汇总的患病率和耐药模式的GNEBP的数据荟萃分析埃塞俄比亚的肺炎患者。使用Google Scholar、PubMed、Science Direct、HINARI数据库和既往研究的参考文献列表，通过互联网检索进行了全面的文献检索。根据先前设定的纳入和排除标准，将已发表的文章纳入研究。结果以95%置信区间（CI）的森林图、表格和图显示。使用不一致指数（I2）检验统计量评估研究间的异质性。通过随机效应模型计算GNEBP的合并患病率估计值及其耐药模式。使用统计学和数据科学软件（STATA）第14版统计软件进行分析。在删除不符合纳入标准的文章后，43项研究被纳入分析。在全国8个地区进行了研究，发表的大多数文章来自阿姆哈拉地区（30.23%），其次是奥罗米亚地区（18.60%）和南方民族地区（18.60%）。GNEBP的合并患病率为15.81%（CI = 13.33-18.29）。漏斗图表明存在发表偏倚。在阿迪斯、阿姆哈拉、南部非洲土著民族和奥罗米亚地区，GNEBP的合并患病率分别为20.08%、16.67%、12.12%和11.61%。在2006-2010年、2011-2015年和2016-2021年进行的研究中，合并患病率分别为14.91%、18.03%和13.46%，年龄小于或等于15岁的儿童患病率最高（20.35%）。大肠埃希菌、弯曲杆菌属、志贺氏菌属，沙门氏菌检出率分别为19.79、10.76、6.24和5.06%。大部分（60-90%）的分离株对氨苄青霉素、阿莫西林、四环素和甲氧苄啶-磺胺甲恶唑耐药。多药耐药（MDR）的合并发生率为70.56%（CI = 64.56-76.77%），志贺氏菌属，E. coli和S.肠分别为80.78、79.08、78.20和59.46%。汇总估计值显示，埃塞俄比亚GNEBP感染的负担很高，对常用抗菌药物的耐药特征比例很高。因此，需要进行药敏试验，建立抗菌药物监测系统，并通过分子技术进行确认。
Diarrhoea is the leading cause of morbidity and mortality in the world particularly in developing countries and among vulnerable groups of the population. Gram-negative enteric bacterial pathogens (GNEBPs) are a group of organisms that reside mainly in the intestine and induce diarrhoea. Antimicrobial agents are usually the part of their treatment regimen. The therapeutic effect of antimicrobials is hindered by the emergence and spread of drug-resistant strains. The information regarding the prevalence and antimicrobial resistance patterns of GNEBPs in Ethiopia is limited and found in a scattered form. This study was designed to determine the pooled prevalence and drug resistance patterns of GNEBPs by meta-analysis of data from diarrhoeic patients in Ethiopia. A comprehensive literature search was conducted through internet searches using Google Scholar, PubMed, Science Direct, HINARI databases, and reference lists of previous studies. Published articles were included in the study based on priorly set inclusion and exclusion criteria. Results were presented in the forest plot, tables, and figures with a 95% confidence interval (CI). The inconsistency index (I2) test statistics was used to assess heterogeneity across studies. The pooled prevalence estimate of GNEBPs and their drug resistance patterns were computed by a random-effects model. Software for Statistics and Data Science (STATA) version 14 statistical software was used for the analysis. After removing those articles which did not fulfil the inclusion criteria, 43 studies were included in the analysis. Studies were conducted in 8 regions of the country and most of the published articles were from the Amhara region (30.23%) followed by Oromia (18.60%) and Southern Nations, Nationalities, and Peoples’ region (SNNP) (18.60%). The pooled prevalence of GNEBPs was 15.81% (CI = 13.33–18.29). The funnel plot indicated the presence of publication bias. The pooled prevalence of GNEBPs in Addis Ababa, Amhara, SNNP, and Oromia regions were 20.08, 16.67, 12.12, and 11.61%, respectively. The pooled prevalence was 14.91, 18.03, and 13.46% among studies conducted from 2006–2010, 2011–2015, and 2016–2021, respectively and it was the highest (20.35%) in children having age less than or equal to 15 years. The pooled prevalence of Escherichia coli, Campylobacter spp., Shigella spp., and Salmonella enterica were 19.79, 10.76, 6.24, and 5.06%, respectively. Large proportions (60–90%) of the isolates were resistant to ampicillin, amoxicillin, tetracycline, and trimethoprim-sulphamethoxazole. The pooled prevalence of multidrug resistance (MDR) was 70.56% (CI = 64.56–76.77%) and MDR in Campylobacter spp., Shigella spp., E. coli, and S. enterica. were 80.78, 79.08, 78.20, and 59.46%, respectively. The pooled estimate showed a high burden of GNEBPs infections and a high proportion of drug resistance characters to commonly used antimicrobial agents in Ethiopia. Therefore, performing drug susceptibility tests, establishing an antimicrobial surveillance system and confirmation by molecular techniques are needed.
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