High rate of extended-spectrum beta-lactamase-producing gram-negative infections and associated mortality in Ethiopia: a systematic review and meta-analysis

Abstract

Background: Extended-spectrum beta-lactamase (ESBL)-producing Gram-negative bacteria have become a serious threat to global health. Their rapid spread is associated with high mortality due to ineffective antibiotic treatment. To date a regular surveillance of multidrug-resistant (MDR) pathogens in Ethiopia is not established. For this report, published data regarding ESBL-producing bacteria in different health facilities of Ethiopia were reviewed. Methods: This study collates data from published information on the rates and clinical implications of infection with ESBL-producing Gram-negative bacteria in Ethiopia. A systematic literature search was conducted using PubMed, PubMed Central, Medline, Science Direct and Google scholar from October 2018 to March 2019. Eligible studies were identified by applying quality criteria. The pooled proportion of ESBL-producing Gram-negative bacteria was estimated based on a random effect model. The publication bias and the variation in proportion estimates attributed to heterogeneity were assessed. Results: Fourteen studies with relevant data were included in the review. In total, 1649 Gram-negative bacteria isolated from 5191 clinical samples were included. The pooled proportion estimate of ESBL-producing Gramnegative bacteria was 50% (95% CI: 47.7-52.5%. Data showed a high level of heterogeneity (I 2 = 95%, P < 0.01). ESBL rates varied by species; 65.7% (263/400) in Klebsiella spp., 48.4% (90/186) in Salmonella spp., and 47.0% (383/ 815) in E. coli. ESBL-encoding genes were reported in 81 isolates: 67 isolates harbored the CTX-M-1 group and 14 isolates TEM. The mortality associated with infections by bacteria resistant to third generation cephalosporins has rarely been investigated. However, two studies reported a mortality of 33.3% (1/3) and 100% (11/11).

Colonization with extended-spectrum cephalosporin-resistant Enterobacterales (ESCrE) and carbapenem-resistant Enterobacterales (CRE) in healthcare and community settings in Botswana: an antibiotic resistance in communities and hospitals (ARCH) study

“…Although advances have been made in our understanding of the epidemiology of these organisms in high-income countries ( Han et al, 2017 ;Han et al, 2012 ;Lautenbach et al, 2012 ;Sheu et al, 2018 ), few data exist from low and middle-income countries (LMICs). Studies that have been conducted in LMICs have been limited because of inconsistent identification and susceptibility testing, reliance on only clinical specimens, and a primary focus on the hospital setting ( Andrew et al, 2017 ;Bulabula et al, 2017 ;Saravanan et al, 2018 ;Singh-Moodley and Perovic, 2016 ;Sonda et al, 2016 ;Tufa et al, 2020 ;Workneh et al, 2017 ). In addition, most previously published research data has been focused on healthcare-associated infections (HAIs), and there are minimal data on colonization by ESCrE and CRE within individuals in community and healthcare settings ( Andrew et al, 2017 ;Saravanan et al, 2018 ;Singh-Moodley and Perovic, 2016 ;Tufa et al, 2020 ;Workneh et al, 2017 ).…”

“…Studies that have been conducted in LMICs have been limited because of inconsistent identification and susceptibility testing, reliance on only clinical specimens, and a primary focus on the hospital setting ( Andrew et al, 2017 ;Bulabula et al, 2017 ;Saravanan et al, 2018 ;Singh-Moodley and Perovic, 2016 ;Sonda et al, 2016 ;Tufa et al, 2020 ;Workneh et al, 2017 ). In addition, most previously published research data has been focused on healthcare-associated infections (HAIs), and there are minimal data on colonization by ESCrE and CRE within individuals in community and healthcare settings ( Andrew et al, 2017 ;Saravanan et al, 2018 ;Singh-Moodley and Perovic, 2016 ;Tufa et al, 2020 ;Workneh et al, 2017 ). Colonization is typically a prerequisite for infection and an important stage in pathogenesis ( Emmanuel Martinez et al, 2019 ;Massart et al, 2020 ;McConville et al, 2017 ;Reddy et al, 2007 ).…”

Occurrence and distribution of extended-spectrum β-lactamase in clinical Escherichia coli isolates at Ho Teaching Hospital in Ghana.

“…In the United Kingdom, the mortality rate from bacteraemia infection caused by ESBL-producing E. coli was 60.9% as against 27.3% from those that did not produce ESBL. 8 In their systematic review and meta-analysis in Ethiopia, Tufa et al 9 reported a death rate of 33.3% and 100.0% due to infections caused by ESBL-producing gram-negative isolates in two separate studies. Infection with ESBL-producing organisms is severe in developing countries like Ghana.…”

Characterization of the emerging multidrug‐resistant Salmonella enterica serotype Kentucky ST314 in China

“…Kentucky has led to the identification of several different STs; these involve strains containing a range of genes that confer resistance to multiple drugs (Haley et al, 2017). Cephalosporin antibiotics play an important role in the treatment of clinical patient infections and the main mechanisms of cephalosporins resistance in Salmonella are mediated by extended-spectrum beta-lactamases (ESBL) genes (Bae et al, 2015;Tufa et al, 2020). The Salmonella genomic island 1 (SGI1) refers to a gene cluster with typical characteristics on the bacterial chromosome, which carries multiple drug-resistance genes and determines the multidrug resistance of the bacteria (Carraro et al, 2017).…”