Systematic review and meta‐analysis of integrated studies on antimicrobial resistance genes in Africa—A One Health perspective

Escher, Nora A; Muhummed, Abdifatah; Hattendorf, Jan; Vonaesch, Pascale; Zinsstag, Jakob

doi:10.1111/tmi.13642

Cited by 16 publications

(25 citation statements)

References 28 publications

(38 reference statements)

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“… 49 The number of interdisciplinary studies included in this review was low (7%; n=9/130; Figure 3 ). Similarly, O’Neal et al review for Central America 50 and Escher et al review for Africa 51 found small numbers of One Health-related studies. Thus, apart from South America, other world regions also struggle to incorporate One Health approaches to their experimental designs; a reality that might be tackled with international cooperation, executing multi-sectorial action plans as proposed by the WHO.…”

Section: Discussionmentioning

confidence: 96%

Extended-Spectrum Beta-Lactamases Producing Escherichia coli in South America: A Systematic Review with a One Health Perspective

Bastidas-Caldes¹,

Romero-Álvarez²,

Valdez-Vélez³

et al. 2022

IDR

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Purpose Extended-spectrum beta-lactamase-producing (ESBL) Enterobacteriaceae, which includes Escherichia coli , has emerged as a global health threat. ESBL enzymes including CTX-M, TEM, and SHV are the most detected. Here, a systematic review was developed to assess the status of ESBLs in E. coli considering studies performed in the human, animal, food, and environmental realms in South America. Methods Following PRISMA guidelines, a systematic review was performed using the PubMed database as a primary source to identify studies containing data on ESBL-producing E. coli in South America. To obtain a comprehensive sample, studies in English, Spanish, and Portuguese were included from 1990 to April 2021. Inclusion such as the reporting of sample origin and diagnostic method and exclusion criteria such as review/letter articles were established to complete data extraction steps. Results Amongst 506 articles retrieved, 130 met the inclusion criteria. Brazil reported 65 (50%) of publications, followed by Argentina, and Ecuador with 11.5% each. According to the category of studies, human studies represented the 56%, animals the 20%, environmental the 11%, and food studies the 6%. Interestingly, studies assessing more than one category (ie, interdisciplinary) represented the 7%. Prevalence of ESBL producing E. coli in animal, food, and environmental studies was widely superior compared to human sources. In clinical studies, Brazil presented the greatest diversity in terms of ESBLs, featuring CTX-M, TEM, SHV, TOHO, OXA, and AmpC. CTX-M enzymes were the most frequent variants with 89.4% detections. Conclusion The present One Health review of 130 studies conducted over the past 21 years found ESBLs producing E. coli distributed across human, animal, food, and environmental samples across South America. There is a need to increment studies in underrepresented countries and to strengthen multi-sectoral antimicrobial resistance research and surveillance. This information can be used as basis for subsequent implementation of monitoring programs, targeting potential critical points of transmission sources.

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Section: Discussionmentioning

confidence: 96%

Extended-Spectrum Beta-Lactamases Producing Escherichia coli in South America: A Systematic Review with a One Health Perspective

Bastidas-Caldes¹,

Romero-Álvarez²,

Valdez-Vélez³

et al. 2022

IDR

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“…Only records that were available on or after January 1, 2000 were included based on related systematic reviews using this cutoff. 18 , 32 Likewise, “resistome” was not used in scientific literature before 2006, 33 so, to reduce the number of studies only assessing a subset of ARGs in the resistome but not exclude resistome-type studies published before 2006, the cutoff of 2000 was used as a conservative restriction. Only papers written in English were included due to resource limitations.…”

Section: Methodsmentioning

confidence: 99%

“… 12 Perturbations to the gut microbiome have been associated with numerous health concerns including loss of colonization resistance, 8 , 13 an increase in potentially pathogenic antibiotic-resistant organisms, 14 and reduced microbiome resiliency due to decreases in strain-level diversity. 15 , 16 Systematic literature reviews have attempted to assess the human gut resistome, 17 , 18 but persistent gaps remain, including our understanding of how perturbations lead to alterations in ARG composition and diversity.…”

Section: Introductionmentioning

confidence: 99%

The association between early life antibiotic exposure and the gut resistome of young children: a systematic review

et al. 2022

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Antimicrobial resistance is a growing public health burden, but little is known about the effects of antibiotic exposure on the gut resistome. As childhood (0–5 years) represents a sensitive window of microbiome development and a time of relatively high antibiotic use, the aims of this systematic review were to evaluate the effects of antibiotic exposure on the gut resistome of young children and identify knowledge gaps. We searched PubMed, Scopus, Web of Science, and the Cochrane Central Register of Controlled Trials. A PICO framework was developed to determine eligibility criteria. Our main outcomes were the mean or median difference in overall resistance gene load and resistome alpha diversity by antibiotic exposure groups. Bias assessment was completed using RoB 2 and ROBINS-I with quality of evidence assessed via the GRADE criteria. From 4885 records identified, 14 studies (3 randomized controlled trials and 11 observational studies) were included in the qualitative review. Eight studies that included information on antibiotic exposure and overall resistance gene load reported no or positive associations. Inconsistent associations were identified for the nine studies that assessed resistome alpha diversity. We identified three main groups of studies based on study design, location, participants, antibiotic exposures, and indication for antibiotics. Overall, the quality of evidence for our main outcomes was rated low or very low, mainly due to potential bias from the selective of reporting results and confounding. We found evidence that antibiotic exposure is associated with changes to the overall gut resistance gene load of children and may influence the diversity of antimicrobial resistance genes. Given the overall quality of the studies, more research is needed to assess how antibiotics impact the resistome of other populations. Nonetheless, this evidence indicates that the gut resistome is worthwhile to consider for antibiotic prescribing practices.

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“… 8 For instance, antimicrobial‐resistant bacterial strains could lead to untreatable infections and cause 10 million deaths each year by 2050. 9 Understanding AMR in Africa post‐COVID‐19 can prevent its extension and avoidable deaths. However, little is known about AMR in the post‐COVID‐19 context in Africa.…”

Section: Introductionmentioning

confidence: 99%

“…It is a public health problem that transcends continents and national borders and is rapidly growing, as seen with the sixfold increase in resistance rates since 2017 8 . For instance, antimicrobial‐resistant bacterial strains could lead to untreatable infections and cause 10 million deaths each year by 2050 9 . Understanding AMR in Africa post‐COVID‐19 can prevent its extension and avoidable deaths.…”

Section: Introductionmentioning

confidence: 99%

Curbing antimicrobial resistance in post‐COVID Africa: Challenges, actions and recommendations

Shomuyiwa

Lucero‐Prisno

Manirambona

et al. 2022

Health Science Reports

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Background Antimicrobial self‐medication and use have significantly increased in the COVID‐19 era—increasing antibiotic consumption and resulting in a high prevalence of antimicrobial resistance in Africa (AMR). We conducted a narrative review to investigate challenges associated with curbing AMR in a post‐COVID‐19 setting in Africa, suggesting practical measures applicable for policy‐informed implementation. Method A narrative review was performed to pinpoint AMR challenges and actions on the African continent. A comprehensive search was conducted in the scientific databases that include PubMed, PubMed Central and Google Scholar using predetermined search terms. Results The emergence of the COVID‐19 outbreak has added to the challenges of tackling AMR on the continent, which has jeopardized AMR interventions' hard‐won gains. Identified challenges have been Health systems disruption, Irrational Antimicrobial Use, Weak Antimicrobials Regulatory Ecosystem, Inefficient Population Infection Prevention, and Control Practices, Inadequate access to Health Services and data challenge on AMR surveillance. Conclusion The COVID‐19 pandemic fueled AMR in Africa. There is a need for AMR control post‐COVID, such as measures for ongoing antimicrobial stewardship and good infection control practices. Further, curbing AMR requires rigorous regulatory enforcement and efficient AMR Surveillance. There should be a body to raise AMR awareness among the population. Research, Innovation and Technology could play an essential role supported by capacity building and global partnership.

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Systematic review and meta‐analysis of integrated studies on antimicrobial resistance genes in Africa—A One Health perspective

Cited by 16 publications

References 28 publications

Extended-Spectrum Beta-Lactamases Producing Escherichia coli in South America: A Systematic Review with a One Health Perspective

Extended-Spectrum Beta-Lactamases Producing Escherichia coli in South America: A Systematic Review with a One Health Perspective

The association between early life antibiotic exposure and the gut resistome of young children: a systematic review

Curbing antimicrobial resistance in post‐COVID Africa: Challenges, actions and recommendations

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