Prevalence of vancomycin-resistant enterococcus in Africa in one health approach: a systematic review and meta-analysis

Abstract

Vancomycin-resistant enterococci are a global challenge currently as reported by the World Health Organization. It is also important to recognize that combating antimicrobial resistance needs to recognize the interconnections between people, animals, plants and their shared environment in creating public health, the so-called One Health approach. Although the presence of VRE has been described in many regions of the world, there is a lack of comprehensive data indicating their prevalence of in Africa. Therefore, this study aimed to aggregate the result of studies describing VRE reported across multiple regions in Africa. A literature search was conducted on PubMed, Google scholar, and Hinari with the term “Vancomycin resistance enterococcus in Africa” on August 1–3, 2019. All available articles were downloaded to “Endnote version 7.1” then to Microsoft Word 2013. Articles determined to meet our criteria for the review was extracted to Microsoft Excel 2013. Those articles that reported the prevalence of vancomycin resistance Enterococcus obtained from all sample types and published from 2010 to 2019 in the English language were included for the review. A meta-analysis was conducted with OpenMetaAnalyst version R.3.1.0 software. The effect size was determined using a binary random effect model and statically significant considered when p < 0.05. Heterogeneity determined with the inconsistency index. A leave one out analysis used to perform the sensitivity analysis. There were 151 articles identified from the database searches; of this, 36 articles included after extensive review with two independent authors. Out of 4073 samples collected, 1488 isolates identified with an overall pooled prevalence of VRE 26.8% (95% CI; 10.7–43.0%) in Africa with a one-health perspective. The analysis showed that considerable heterogeneity among the studies (I2 = 99.97%; p < 0.001). Subgroup analysis in-country, African region, laboratory method, year of publication, and sample source showed that a high prevalence was identified from South Africa (74.8%), South African regions (74.8%), PCR (959.2%), 2010–2015 years (30.3%) and environmental (52.2%), respectively. This meta-analysis indicates that there was a high-pooled prevalence of vancomycin-resistant enterococci in African. A lot should be done to prevent and control the transmission of vancomycin resistance enterococci to a human being from the environment in the continent.

High-Resolution Genotyping Unveils Identical Ampicillin-Resistant Enterococcus faecium Strains in Different Sources and Countries: A One Health Approach

“…The unnoticed small outbreak detected in this work, together with the scarce number of published epidemiological studies detecting VREfm in healthcare institutions of Tunisia since 2007 [ 12 , 13 , 14 , 22 ], highlights the fact that VREfm numbers in this country may be higher than estimated. Indeed, a recent systematic review and meta-analysis developed by Alemayehu and Hailemariam [ 23 ] identified a high-pooled prevalence of VREfm enterococci in African countries, with Tunisia, despite everything, being one of the countries that most contributed to such analysis (just surpassed by South Africa and Ethiopia).…”

Metagenomic analysis of the abundance and composition of antibiotic resistance genes in hospital wastewater in Benin, Burkina Faso, and Finland

“…The more common occurrence of van genes in HWWs from Finland compared to Benin or Burkina Faso suggests that vancomycin-resistant Enterococci (VRE) causing severe difficult-to-treat-infections 16 are more frequent in hospitals in Finland, possibly due to differences in the consumption of vancomycin in different countries. Only one of the West African hospitals reported vancomycin among the most used antibiotics (Supplementary Material, Table S1A).…”

“…They can feature an impressive resistance profile in terms of both intrinsic and acquired ARGs and often exhibit multidrug resistant phenotypes. For instance, hospital-associated strains of methicillin-resistant S. aureus (MRSA) carrying the mec 17 gene that encodes a beta-lactamase and vancomycin-resistant Enterococci (VRE) carrying the van gene 16 are clinically important pathogens in hospitals and are both associated with increased mortality 1,18 . However, investigating only bacterial isolates may result in limited understanding of ARGs occurring in a particular hospital.…”

“…The high-risk ESKAPEEc bacteria 6 (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp. and Escherichia coli) 15 are top priority pathogens for AMR research and the development of new antibiotics 6,16 . They can feature an impressive resistance profile in terms of both intrinsic and acquired ARGs and often exhibit multidrug resistant phenotypes.…”

Uso de CRISPR-Cas em plasmídeos conjugativos para o controle da disseminação de resistência a antibióticos em Enterococcus: uma revisão de literatura.

“…Com relação a E. faecium, há relatados de aumento significativo da prevalência da resistência a Vancomicina na Turquia, África, Etiópia, Nigéria (Kilbas et al, 2018;Alemayehu et al, 2020;Melese, et al, 2020;Wada, et al, 2020). Além disso, essa mesma tendência de aumento da resistência aos antibióticos, tem sido vista em outros estudos que apontam o aumento da prevalência da resistência aos aminoglicosídeos, tanto em E. faecium quanto em E. faecalis, no Irã e até mesmo no Brasil (Peyvasti, et al, 2020;Jannati et al, 2020;Bender, et al, 2009).…”