The growing challenges of antibacterial drug resistance in Ethiopia

Moges, Feleke; Endris, Mengistu; Mulu, Andargachew; Tessema, Belay; Belyhun, Yeshambel; Shiferaw, Yitayal; Huruy, Kahsay; Unakal, Chandrashekhar; Kassu, Afework

doi:10.1016/j.jgar.2014.02.004

Cited by 52 publications

(59 citation statements)

References 29 publications

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“…Although antimicrobial resistance surveillance centers were established and priority surveillance pathogens were identified to prevent the spread of drug resistance in Ethiopia, VRE were not included in the lists of priority pathogens. A previous systematic review [26] reporting the growing challenges of antibacterial resistance in Ethiopia had not assessed the burden of drug resistant enterococci. The prevalence of VRE has been reported by several studies in Ethiopia but a comprehensive review covering different parts of Ethiopia has not been conducted.…”

Section: Discussionmentioning

confidence: 99%

“…To prevent and contain the spread of drug resistance, the Ethiopian Public Health Institute (EPHI) established AMR surveillance centers and identified national priority surveillance pathogens in 2017 [4]. A previous systematic review has also reported the growing challenges of antibacterial drug resistance in Ethiopia [26]; but VRE were included neither in the national priority surveillance pathogens nor in previous systematic reviews. Although the rising rates of VRE infections are being reported elsewhere in the worldwide; there is limited national pooled data in Ethiopia.…”

Section: Introductionmentioning

confidence: 99%

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

2020

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

2020

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“…Many bacteria species isolated from different clinical specimens have showed one or more resistance mechanisms to each of the major classes of antimicrobial agents [5, 6]. MDR bacteria acquire resistance by mutation or gene transfer through conjugation, transformation or transduction.…”

Section: Introductionmentioning

confidence: 99%

Bacterial agents and antibiotic resistance profiles of infections from different sites that occurred among patients at Debre Markos Referral Hospital, Ethiopia: a cross-sectional study

et al. 2017

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BackgroundIn developing countries like Ethiopia, infections with antibiotic resistant bacteria become a real threat. Hence, monitoring of local level antimicrobial resistance profile is indispensable to contain the spread of drug resistant bacteria and intervene poor awareness on antimicrobial resistance. Therefore, this study aimed at determining bacterial and antibiotic resistance profiles of infections from different sites that occurred among patients.MethodsRetrospective data recorded were analyzed on culture and drug susceptibility test results at Debre Markos Referral Hospital which were performed from 2011 to 2014. Drug susceptibility tests were performed using disk-diffusion technique. Chi square test was computed to compare the proportion of bacterial isolates with patients’ age and sex.ResultsOut of 575 clinical samples processed, 280 (48.7%) were culture positive for aerobic bacteria pathogens. Wound 238 (41.4%) and urine 108 (18.8%) were the most frequent samples processed. Overall, Staphylococcus aureus (S. aureus) was the predominant isolate 100 (31.5%) followed by Escherichia coli (E. coli) 39 (13.8%), Pseudomonas aeruginosa (P. aeruginosa) 30 (10.3%) and Salmonella spp. 25 (8.9%). P. aeruginosa was the most frequent isolate followed by S. aureus from ear infection. E. coli was the leading isolate followed by Klebsiella spp. from urinary tract infection. Salmonella and Shigella spp. were the most frequent isolates in stool in children below 5 years of age. Neisseria gonorrhoeae (N. gonorrhoeae) 16 (76.2%) was the most common isolate from urethral discharge. The overall multidrug-resistant Gram positive and Gram negative bacteria isolates were 113 (84.6%) and 96 (72.2%), respectively. Gram positive bacteria revealed resistance to cotrimoxazole (80%), gentamicin (83.1%), amoxicillin (85.1%), ampicillin (85.8%), penicillin (89.7%), clindamycin (93.2%) and erythromycin (90.9%). Gram negative bacteria showed resistance to cotrimoxazole (53.1%), amoxicillin (58.8%), ampicillin (70.4%), tetracycline (75.9%) and gentamicin (76.9%).ConclusionsVarious bacterial infections linked with high levels of MDR bacteria pathogens are major health problems in the study area. Therefore, treatment of common bacterial infections in the study area needs to be guided by drug-susceptibility testing of isolates.

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“…According to recent review made in Ethiopia (Mogese et al, 2014), some of the antibiotics have become virtually useless, alarming for the urgent need to apply antibiotic restriction policies as well as measures to prevent further spread of resistant clones. Thus, the pressure due to drug resistance necessitates search for novel antimicrobial substances from plants as the development of resistance to bioactive substance from plants is low, if any (Bacha et al, 2016).…”

Section: Discussionmentioning

confidence: 99%

Antibacterial activity of selected medicinal plants used in South-western Ethiopia

Begashawu¹,

Tariku²,

Bacha³

2016

Afr. J. Microbiol. Res.

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673.3 mm), respectively. The lowest MIC observed in the current study was 5.6 mg/mL and recorded for both petroleum and chloroform extracts of leaves of R. multifidus, L. martinicensis, and K. begonifolia against S. aureus. The observed antibacterial activities could be accounted to combinations of phytochemical compounds isolated from the test plants including alkaloids, tannins, flavonoids, terpenoids and cardiac glycosides. Leaves of the three traditional medicinal plants evaluated in the current study displayed promising antibacterial activities against bacterial test strain. However, the highest activity was observed in petroleum ether extract of stems of K. begonifolia against all test strains with Inhibition Zone (IZ) diameter ranging between 28-31 mm. Further toxicity and pharmacokinetic study are recommended.

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The growing challenges of antibacterial drug resistance in Ethiopia

Cited by 52 publications

References 29 publications

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

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

Bacterial agents and antibiotic resistance profiles of infections from different sites that occurred among patients at Debre Markos Referral Hospital, Ethiopia: a cross-sectional study

Antibacterial activity of selected medicinal plants used in South-western Ethiopia

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