Prevalence of Vancomycin resistant enterococci (VRE) in Ethiopia: a systematic review and meta-analysis

Abstract

Background: The emergence of Vancomycin resistant enterococci (VRE) poses a major public health problem since it was first reported. Although the rising rates of VRE infections are being reported elsewhere in the worldwide; there is limited national pooled data in Ethiopia. Therefore, this study was aimed to estimate the pooled prevalence of VRE and antimicrobial resistance profiles of enterococci in Ethiopia. Methods: Literature search was done at PubMed, EMBASE, Google scholar, African Journals online (AJOL) and Addis Ababa University repository following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Both published and unpublished studies reporting the prevalence of VRE until June 30, 2019 were included. Data were extracted using Microsoft Excel and copied to Comprehensive Meta-analysis (CMA 2.0) for analysis. Pooled estimate of VRE was computed using the random effects model and the 95% CIs. The level of heterogeneity was assessed using Cochran's Q and I 2 tests. Publication bias was checked by visual inspection of funnel plots and Begg's and/or Egger's test. Results: Twenty studies fulfilled the eligibility criteria and found with relevant data. A total of 831 enterococci and 71 VRE isolates were included in the analysis. The pooled prevalence of VRE was 14.8% (95% CI; 8.7-24.3; I 2 = 74.05%; P < 0.001). Compared to vancomycin resistance, enterococci had higher rate of resistance to Penicillin (60.7%), Amoxicillin (56.5%), Doxycycline (55.1%) and Tetracycline (53.7%). Relatively low rate of resistance was found for Daptomycin and Linezolid with a pooled estimate of 3.2% (95% CI, 0.5-19.7%) and 9.9% (95% CI, 2.8-29.0%); respectively. The overall pooled multidrug resistance (MDR) rate of enterococci was 60.0% (95% CI, 42.9-75.0%). Conclusion: The prevalence of VRE and drug resistant enterococci are on the rise in Ethiopia. Enterococcal isolates showed resistance to one or more of the commonly prescribed drugs in different or the same drug lines. Multidrug resistant (MDR) enterococci were also found. Although the rates were low, the emergence of resistance to Daptomycin and Linezolid is an alarm for searching new ways for the treatment and control of VRE infections. Adherence to antimicrobial stewardship, comprehensive testing and ongoing monitoring of VRE infections in the health care settings are required.

The Prevalence of Virulent and Multidrug-Resistant Enterococci in River Water and in Treated and Untreated Municipal and Hospital Wastewater

“…Enterococcus faecalis and E. faecium are highly resistant to aminoglycosides around the world [ 12 , 68 ], including in Poland [ 14 ]. More than 50% of E. faecalis and E. faecium strains identified in Ethiopia were resistant to vancomycin, penicillin, amoxicillin, doxycycline, and tetracycline, and 60.0% of all identified enterococci were classified as MDR [ 31 ]. In the present study, enterococcus strains isolated 500 m downstream from the wastewater discharge point had similar antibiotic resistance profiles, and most of them were resistant to trimethoprim (87.5%), vancomycin, and teicoplanin (more than 75% of the strains).…”

“…However, this gene is increasingly often identified in E. faecium and E. faecalis , which suggests that it can be acquired from E. gallinarum and E. casseliflavus by horizontal transfer [ 72 ]. Multidrug-resistant enterococci and VRE have been spreading at an alarming rate in both hospitals [ 31 , 73 ] and the natural environment [ 41 , 65 ]. These pathogens could originate from various sources which have not been fully elucidated to date.…”

“…In 2018, the highest number of clinical VRE isolates of E. faecium were determined in Romania (40.3%), Ireland (40.2%), and Poland (35.8%), (ECDC 2020). Vancomycin-resistant enterococci are isolated in various countries (Ethiopia—4.8%, North America—21%, Asia—24%, Europe—20%), and their prevalence is influenced by the applied isolation method, time of analysis, and the size of the studied population [ 30 , 31 ]. Some species harbor virulence factors, including cytolysin which facilitates cell lysis ( cyl A), aggregation substance (AS), gelatinase which hydrolyzes gelatin, casein, and hemoglobin ( gel E), hyaluronidase which increases the invasiveness of bacteria ( hyl ), endocarditis antigen ( efa A), factor-encoding surface protein that participates in biofilm formation ( esp ), and sex pheromones that carry ARGs ( cob , c pd , and ccf ) [ 32 , 33 , 34 ].…”

Vancomycin-resistant enterococci and coagulase-negative staphylococci prevalence among patients attending at Felege Hiwot Comprehensive Specialized Hospital, Bahir Dar, Ethiopia

“…Resistance development by enterococci and CoNS for different antibiotics including vancomycin is a growing challenge globally [ 3 , 17 – 19 ]. Vancomycin resistance for CoNS and enterococci were reported immediately after vancomycin was discovered [ 4 , 5 , 20 , 21 ].…”

Chances and prevention of antibiotic resistance in primary health care: literature review

“…In Ethiopia, Melese et al estimated the prevalence rate to be 14.8% (95% CI: 8.7-24.3) while in Nigeria, Wada et al estimated the prevalence of VRE from 19 original investigations to be 25.3% (95% CI: 19.8-30.8%) Acinetobacter baumannii resistance to antibiotics was also reported by many previous investigations which showed that the prevalence rate of this resistance was hugely variable according to the applied antibiotic per country. 19,20 Pormohammad et al analyzed the results of 150 original investigations in a single meta-analysis to estimate the prevalence rate of cefotaxime and colistin by country. 21 Africa had a 99% prevalence resistance rate to cefotaxime which was the highest while countries in the Western Pacific had the lowest prevalence rate of 1.1%.…”