Prevalence of carbapenemase-producing Enterobacteriaceae from human clinical samples in Ethiopia: a systematic review and meta-analysis

Abstract

Introduction Carbapenemase-producing Enterobacteriaceae are by far the most public health and urgent clinical problems with antibiotic resistance. They cause longer hospital stays, more expensive medical care, and greater mortality rates. This systematic review and meta-analysis aimed to indicate the prevalence of carbapenemase-producing Enterobacteriaceae in Ethiopia. Methods This systematic review and meta-analysis was conducted based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. Electronic databases like PubMed, Google Scholar, CINAHL, Wiley Online Library, African Journal Online, Science Direct, Embase, ResearchGate, Scopus, and the Web of Sciences were used to find relevant articles. In addition, the Joanna Briggs Institute quality appraisal tool was used to assess the quality of the included studies. Stata 14.0 was used for statistical analysis. Heterogeneity was assessed by using Cochran’s Q test and I2 statistics. In addition, publication bias was assessed using a funnel plot and Egger’s test. A random effect model was used to estimate the pooled prevalence. Sub-group and sensitivity analysis were also done. Results The overall pooled prevalence of carbapenemase-producing Enterobacteriaceae in Ethiopia was 5.44% (95% CI 3.97, 6.92). The prevalence was highest [6.45% (95% CI 3.88, 9.02)] in Central Ethiopia, and lowest [(1.65% (95% CI 0.66, 2.65)] in the Southern Nations and Nationalities People Region. In terms of publication year, 2017–2018 had the highest pooled prevalence [17.44 (95% CI 8.56, 26.32)] and 2015–2016 had the lowest [2.24% (95% CI 0.87, 3.60)]. Conclusion This systematic review and meta-analysis showed a high prevalence of carbapenemase-producing Enterobacteriaceae. So, to alter the routine use of antibiotics, regular drug susceptibility testing, strengthening the infection prevention approach, and additional national surveillance on the profile of carbapenem resistance and their determining genes among Enterobacteriaceae clinical isolates are required. Systematic review registration PROSPERO (2022: CRD42022340181).

Distribution of ß-Lactamase Genes Among Multidrug-Resistant and Extended-Spectrum ß-Lactamase-Producing Diarrheagenic Escherichia coli from Under-Five Children in Ethiopia

“…63,64 A systematic review and meta-analysis showed 5.4% pooled prevalence of carbapenemase-producing Enterobacterales, with high prevalence in Central Ethiopia. 65 Recent data reports bla KPC , bla NDM , and bla OXA-48 from clinical isolates of Enterobacterales in Ethiopia. 66,67 Carbapenemase encoding genes, bla NDM , and bla OXA−48 are becoming the dominant carbapenemase variants in E. coli strains.…”

The Importance of Carbapenemase-Producing Enterobacterales in African Countries: Evolution and Current Burden

“…A 2023 study revealed that of 183 diarrheal pathotype E. coli isolated from children, 4 (2.2%) were CPE [70], while another study evaluating GNB isolated from blood cultures revealed prevalences of 25.1% for CP-GNB and 5.6% for MBL producers among 231 GNB (179 Enterobacterales), with 2% CPE in the studied population [71]. A systematic review from 2023 reported an overall 5.44% pooled prevalence of CPE in Ethiopia, ranging from 2.24% in 2015-2016 to 17.44% in 2017-2018 and from 1.65% in the southern region to 6.45% in Central Ethiopia [72].…”

Molecular characterization of carbapenem-resistance in Gram-negative isolates obtained from clinical samples at Jimma Medical Center, Ethiopia

“…In previous studies conducted in Ethiopia, the rate of carbapenem resistance among Gram-negative rods was low ranging 1.7–15.1% ( Misha et al, 2021 ; Tekele et al, 2021 ; Seman et al, 2022 ; Tilahun et al, 2022 ; Alemayehu et al, 2023 ). However, our findings showed an increase in resistance to carbapenems (18.6%).…”

“…Such infections are major concerns for critically ill patients, immunocompromised individuals, and those with comorbidities ( Aleidan et al, 2021 ; Di Carlo et al, 2021 ). In resource-constrained countries, including Ethiopia, the public health impact is even worse due to the lack of reserve treatment options ( Alemayehu et al, 2023 ; Beshah et al, 2023 ).…”